Individual
KIMBRA L. O'BRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCAC
Contact information
Practice address
1417 N ANTHONY BLVD, FORT WAYNE, IN 46805-5252
(260) 424-5814
(260) 424-6423
Mailing address
1417 N ANTHONY BLVD, FORT WAYNE, IN 46805-5252
(260) 424-5814
(260) 424-6423
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
870001674A
IN
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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