Provider Demographics
NPI:1699429738
Name:COLLIER, KIMARI SHALEIGH (LMSW)
Entity type:Individual
Prefix:MS
First Name:KIMARI
Middle Name:SHALEIGH
Last Name:COLLIER
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 1:4207 CORAL BERRY PATH APT 205
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2163
Mailing Address - Country:US
Mailing Address - Phone:770-990-6846
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD BLDG 131
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW009516104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker