Provider Demographics
NPI:1487305843
Name:HARKER, KIMBERLY LORRAINE (MA, LAC, LISAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LORRAINE
Last Name:HARKER
Suffix:
Gender:F
Credentials:MA, LAC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5579
Mailing Address - Country:US
Mailing Address - Phone:970-577-3153
Mailing Address - Fax:
Practice Address - Street 1:1200 E LAGUNA DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5579
Practice Address - Country:US
Practice Address - Phone:480-800-9538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC155304101YA0400X
COACD.0002047101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)