Provider Demographics
NPI:1790978302
Name:SMITH, KIMBERLY NOEL (EDD, BCBA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NOEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:EDD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 MIDDLEGROUND RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1222
Mailing Address - Country:US
Mailing Address - Phone:901-229-8441
Mailing Address - Fax:941-485-0519
Practice Address - Street 1:11500 MIDDLEGROUND RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1222
Practice Address - Country:US
Practice Address - Phone:901-229-8441
Practice Address - Fax:941-485-0519
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-06-2940103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst