Individual
MS. KIMBERLY EVETTE HEARON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5971 WINCHESTER PL, PORTAGE, IN 46368-4915
(219) 201-0716
Mailing address
5971 WINCHESTER PL, PORTAGE, IN 46368-4915
(219) 201-0716
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87000043A
IN
Other
Enumeration date
09/05/2022
Last updated
09/05/2022
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