Provider Demographics
NPI:1205183068
Name:KIMBLE, TRINITY (MS)
Entity type:Individual
Prefix:
First Name:TRINITY
Middle Name:
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0592
Mailing Address - Country:US
Mailing Address - Phone:407-536-1639
Mailing Address - Fax:
Practice Address - Street 1:6451 OLD PARK LN UNIT 304
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3231
Practice Address - Country:US
Practice Address - Phone:407-536-1639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health