Individual
STACY KIMBROUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
701 W RED BANK AVE, WEST DEPTFORD, NJ 08096-4950
(347) 226-0247
Mailing address
701 W RED BANK AVE, WEST DEPTFORD, NJ 08096-4950
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
687697
PA
Other
Enumeration date
02/13/2017
Last updated
02/13/2017
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