Provider Demographics
NPI:1528663994
Name:TURNER, KIMBERLEY LYNN (CDCA)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:LYNN
Last Name:TURNER
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E ALEX BELL RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2721
Mailing Address - Country:US
Mailing Address - Phone:937-291-2300
Mailing Address - Fax:937-291-2303
Practice Address - Street 1:950 E ALEX BELL RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-2721
Practice Address - Country:US
Practice Address - Phone:937-291-2300
Practice Address - Fax:937-291-2303
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.166314101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1255978300Medicaid