Provider Demographics
NPI:1588163273
Name:DITTO, KIMBERLY KAY (MA, LLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:DITTO
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9757 SUNNYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-7965
Mailing Address - Country:US
Mailing Address - Phone:269-599-6776
Mailing Address - Fax:
Practice Address - Street 1:3030 S 9TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-7956
Practice Address - Country:US
Practice Address - Phone:269-599-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010928101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional