Provider Demographics
NPI:1134364284
Name:KIMBLE, PAMELA MARIE (LLMSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4630
Mailing Address - Country:US
Mailing Address - Phone:906-233-1236
Mailing Address - Fax:906-233-1235
Practice Address - Street 1:200 W SPRING ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4630
Practice Address - Country:US
Practice Address - Phone:906-233-1236
Practice Address - Fax:906-233-1235
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health