Provider Demographics
NPI:1861537524
Name:MCDONALD, KIM (MSW)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4608
Mailing Address - Country:US
Mailing Address - Phone:928-341-0011
Mailing Address - Fax:928-341-0022
Practice Address - Street 1:1414 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4608
Practice Address - Country:US
Practice Address - Phone:928-341-0011
Practice Address - Fax:928-341-0022
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10088101YA0400X
AZLMSW-10080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health