Provider Demographics
NPI:1902495567
Name:VOLZ, KIMBERLY (ACIT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:VOLZ
Suffix:
Gender:F
Credentials:ACIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-3501
Mailing Address - Country:US
Mailing Address - Phone:574-703-4706
Mailing Address - Fax:844-361-2090
Practice Address - Street 1:3030 RUE RENOIR APT 225
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-2815
Practice Address - Country:US
Practice Address - Phone:574-703-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)