Provider Demographics
NPI:1831604651
Name:KEMBEL, KIMBERLY RENEE RILEY (LCDC III)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RENEE RILEY
Last Name:KEMBEL
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:RENEE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDC III
Mailing Address - Street 1:1569 STATE RT 28
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140
Mailing Address - Country:US
Mailing Address - Phone:513-575-0968
Mailing Address - Fax:513-575-1019
Practice Address - Street 1:1569 STATE RT 28
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140
Practice Address - Country:US
Practice Address - Phone:513-575-0968
Practice Address - Fax:513-575-1019
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161155101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)