Individual
KIMBERLY AUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
343 FOREST AVE, PORTLAND, ME 04101-2006
(207) 874-1030
(207) 874-1044
Mailing address
343 FOREST AVE, PORTLAND, ME 04101-2006
(207) 874-1030
(207) 874-1044
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LC10159
ME
101YM0800X
Mental Health Counselor
LC10159
ME
104100000X
Social Worker
Primary
LC10159
ME
106H00000X
Marriage & Family Therapist
LC10159
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104760100
—
ME
Enumeration date
08/14/2006
Last updated
04/23/2013
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