Provider Demographics
NPI:1699318543
Name:MARSH, KIMBERLY KAY (LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:MARSH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4904
Mailing Address - Country:US
Mailing Address - Phone:205-240-7885
Mailing Address - Fax:256-340-9335
Practice Address - Street 1:1608 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4904
Practice Address - Country:US
Practice Address - Phone:256-340-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4883G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4883GOtherLMSW