Provider Demographics
NPI:1013338698
Name:HALL, KIMBERLY ANN (LCSW/LMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW/LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 SPEAR AVE
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4833
Mailing Address - Country:US
Mailing Address - Phone:707-845-4788
Mailing Address - Fax:707-826-8239
Practice Address - Street 1:3798 JANES RD STE 20
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521
Practice Address - Country:US
Practice Address - Phone:707-825-4963
Practice Address - Fax:707-826-8239
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000008759104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker