Provider Demographics
NPI:1962487694
Name:STRICKER, KIMBERLY D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:D
Last Name:STRICKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 STREAMSIDE DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9468
Mailing Address - Country:US
Mailing Address - Phone:423-902-3621
Mailing Address - Fax:423-510-1888
Practice Address - Street 1:8507 STREAMSIDE DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-9468
Practice Address - Country:US
Practice Address - Phone:423-902-3621
Practice Address - Fax:423-510-1888
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW012381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3069671OtherBLUE CROSS BLUE SHIELD
TN3920712Medicaid
3069671OtherBLUE CROSS BLUE SHIELD
3920712Medicare ID - Type Unspecified