Provider Demographics
NPI:1992129290
Name:YON-DAVIS, KIMBERLY S (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:YON-DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 JOHN SIMS PKWY E # 353
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2143
Mailing Address - Country:US
Mailing Address - Phone:850-974-8045
Mailing Address - Fax:850-678-1720
Practice Address - Street 1:4393 COMMONS DR E STE 201
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8482
Practice Address - Country:US
Practice Address - Phone:850-974-8045
Practice Address - Fax:850-678-1720
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW117611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical