Individual
KIMBERLY LIND WACASTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4650 HAWTHORNE RD, SUITE 3B, CHUBBUCK, ID 83202-2376
(208) 237-9833
(208) 237-1800
Mailing address
4650 HAWTHORNE RD, SUITE 3B, CHUBBUCK, ID 83202-2376
(208) 237-9833
(208) 237-1800
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-27911
ID
Other
Enumeration date
06/25/2010
Last updated
06/25/2010
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