Provider Demographics
NPI:1649841230
Name:MILES, KIMBERLY ERIN (LMHC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ERIN
Last Name:MILES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BARTON BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3172
Mailing Address - Country:US
Mailing Address - Phone:321-504-3888
Mailing Address - Fax:321-504-3462
Practice Address - Street 1:500 BARTON BLVD STE 7
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3172
Practice Address - Country:US
Practice Address - Phone:321-504-3888
Practice Address - Fax:321-504-3462
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH4804OtherPROFESSIONAL LICENSE