Provider Demographics
NPI:1831867720
Name:WOODS, KIMBERLIAH (CEO,MT-MSW, CCM,CCHW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLIAH
Middle Name:
Last Name:WOODS
Suffix:
Gender:F
Credentials:CEO,MT-MSW, CCM,CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 E 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8123
Mailing Address - Country:US
Mailing Address - Phone:219-337-9826
Mailing Address - Fax:219-472-0926
Practice Address - Street 1:760 E 92ND AVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8123
Practice Address - Country:US
Practice Address - Phone:219-746-9094
Practice Address - Fax:219-472-0926
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INET04422172V00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172V00000XOther Service ProvidersCommunity Health Worker