Provider Demographics
NPI:1023315108
Name:LEDWA, KIMBERLY OPAL (LCPC, ACADC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:OPAL
Last Name:LEDWA
Suffix:
Gender:F
Credentials:LCPC, ACADC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:OPAL
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1420 SANDAL CRK
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5288
Mailing Address - Country:US
Mailing Address - Phone:208-880-3785
Mailing Address - Fax:
Practice Address - Street 1:17678 DARK ZEBRA WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-9078
Practice Address - Country:US
Practice Address - Phone:208-880-3785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional