Provider Demographics
NPI:1801663257
Name:KIMBALL, JULIE L (BS, MA)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:L
Last Name:KIMBALL
Suffix:
Gender:
Credentials:BS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25387-2510
Mailing Address - Country:US
Mailing Address - Phone:304-233-3200
Mailing Address - Fax:
Practice Address - Street 1:102 PATRICK ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-2510
Practice Address - Country:US
Practice Address - Phone:304-233-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health