Provider Demographics
NPI:1780183012
Name:LAWS, KIMMOY KISHAL
Entity Type:Individual
Prefix:
First Name:KIMMOY
Middle Name:KISHAL
Last Name:LAWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 SWANNANOA ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2945
Mailing Address - Country:US
Mailing Address - Phone:863-838-0466
Mailing Address - Fax:
Practice Address - Street 1:314 SWANNANOA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2945
Practice Address - Country:US
Practice Address - Phone:863-838-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health