Provider Demographics
NPI:1891951109
Name:GREGORY, KIMBERLY M (MSW, LMSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:M
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:151 S ROSE ST
Mailing Address - Street 2:SUITE #605
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4792
Mailing Address - Country:US
Mailing Address - Phone:269-352-4287
Mailing Address - Fax:269-352-4287
Practice Address - Street 1:151 S ROSE ST
Practice Address - Street 2:SUITE #605
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4792
Practice Address - Country:US
Practice Address - Phone:269-352-4287
Practice Address - Fax:269-352-4287
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01130101YA0400X
MI68010905681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)