Individual
KIMBERLY J HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC-S, LICDC
Contact information
Practice address
4464 S DIXIE HWY, MIDDLETOWN, OH 45005-5464
(513) 649-8008
(513) 649-8004
Mailing address
4464 S DIXIE HWY, MIDDLETOWN, OH 45005-5464
(513) 649-8008
(513) 649-8004
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.001245
OH
101YM0800X
Mental Health Counselor
E.0003482-SUPV
OH
101YP2500X
Professional Counselor
Primary
E.0003482-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074861
MEDICAID-ODADAS
OH
01
—
0074946
MEDICAID-ODMH
OH
01
—
01-0693
CARF CERTIFICATION
OH
01
—
236088
NBCC
—
01
—
H130910
MEDICARE GROUP PTAN
OH
Enumeration date
05/12/2007
Last updated
02/09/2017
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