Provider Demographics
NPI:1932543196
Name:COSTELLO, KIMBERLEY D (CADC-D)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:D
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:CADC-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 COLBY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1610
Mailing Address - Country:US
Mailing Address - Phone:248-821-2284
Mailing Address - Fax:
Practice Address - Street 1:2626 COLBY DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-1610
Practice Address - Country:US
Practice Address - Phone:248-821-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)