Provider Demographics
NPI:1427117779
Name:KIMAIGA, DEBRA CANDY (LCSW, LPC, ICS)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:CANDY
Last Name:KIMAIGA
Suffix:
Gender:F
Credentials:LCSW, LPC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-2405
Mailing Address - Country:US
Mailing Address - Phone:262-638-6744
Mailing Address - Fax:262-638-6540
Practice Address - Street 1:1717 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-2405
Practice Address - Country:US
Practice Address - Phone:262-638-6744
Practice Address - Fax:262-638-6540
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI605-125101YP2500X
WI1061-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39617400Medicaid
WI39617400Medicaid
WI56004OtherSECURITY HEALTH PLAN