Individual
MS. KIMBERLY SUE VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MASTER OF EDUCATION
Contact information
Practice address
17195 CLEVELAND RD, SOUTH BEND, IN 46635-1415
(574) 277-0274
(574) 271-7202
Mailing address
17195 CLEVELAND RD, SOUTH BEND, IN 46635-1415
(574) 277-0274
(574) 271-7202
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
39001136A
IN
101YM0800X
Mental Health Counselor
Primary
39001136A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000341223
ANTHEM
IN
05
—
200475040
—
IN
01
—
7381710
AETNA
IN
01
—
793356000
MAGELLAN
IN
Enumeration date
11/13/2006
Last updated
05/17/2024
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