Provider Demographics
NPI:1720328370
Name:HART-OGBURN, KIMBERLEY DEDRAETTE (LPCC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:DEDRAETTE
Last Name:HART-OGBURN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3344 CEDARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2944
Mailing Address - Country:US
Mailing Address - Phone:216-507-0168
Mailing Address - Fax:
Practice Address - Street 1:3344 CEDARBROOK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2944
Practice Address - Country:US
Practice Address - Phone:216-507-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013862101YP2500X
OHE.1700293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional