Provider Demographics
NPI:1053721522
Name:SELLERS, KIMBERLY DAWN (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:SELLERS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7865
Mailing Address - Country:US
Mailing Address - Phone:513-236-4954
Mailing Address - Fax:
Practice Address - Street 1:212 N BROADWAY ST
Practice Address - Street 2:SUITE 7
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-2736
Practice Address - Country:US
Practice Address - Phone:513-228-6023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0800299-SUPV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker