Basic Information
| Provider Information | |||||||||
| NPI: | 1235349945 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPAMPINATO | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 89 W. SOUTH BLVD. SUITE 200 SUITE 200 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487836203 | ||||||||
| FaxNumber: | 2486053525 | ||||||||
| Practice Location | |||||||||
| Address1: | 89 W. SOUTH BLVD. SUITE 200 SUITE 200 | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487836203 | ||||||||
| FaxNumber: | 2486053525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 09/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401008585 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.