Provider Demographics
NPI:1154411791
Name:KIMBLE, SAGE (LPCC)
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 MORNINGSIDE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1035
Mailing Address - Country:US
Mailing Address - Phone:505-265-4727
Mailing Address - Fax:505-266-2236
Practice Address - Street 1:343 MORNINGSIDE DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1035
Practice Address - Country:US
Practice Address - Phone:505-265-4727
Practice Address - Fax:505-266-2236
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health