Provider Demographics
NPI:1881805984
Name:HAVILAND, KIMBERLY ANN (LCSW, CDCI, ADMIN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:HAVILAND
Suffix:
Gender:F
Credentials:LCSW, CDCI, ADMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11312 KENAI SPUR HWY
Mailing Address - Street 2:SUITE 39
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7754
Mailing Address - Country:US
Mailing Address - Phone:907-395-4106
Mailing Address - Fax:907-283-4236
Practice Address - Street 1:11312 KENAI SPUR HWY
Practice Address - Street 2:SUITE 39
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7754
Practice Address - Country:US
Practice Address - Phone:907-395-4106
Practice Address - Fax:907-283-4236
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8641041C0700X
AK2432101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)