Provider Demographics
NPI:1891385803
Name:SLAPE, KIMBERLY ANN HILL
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN HILL
Last Name:SLAPE
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 1:3517 WINDFIELD TER
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8509
Mailing Address - Country:US
Mailing Address - Phone:770-530-8880
Mailing Address - Fax:
Practice Address - Street 1:1216 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2220
Practice Address - Country:US
Practice Address - Phone:770-530-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health