Provider Demographics
NPI:1679993877
Name:WIMBERLY-BROWN, KERI LYNN (MS, LCAC, CADAC IV)
Entity type:Individual
Prefix:MRS
First Name:KERI
Middle Name:LYNN
Last Name:WIMBERLY-BROWN
Suffix:
Gender:F
Credentials:MS, LCAC, CADAC IV
Other - Prefix:MRS
Other - First Name:KERI
Other - Middle Name:LYNN
Other - Last Name:WIMBERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LCAC, CADAC IV
Mailing Address - Street 1:2575 CHASEWAY CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1285
Mailing Address - Country:US
Mailing Address - Phone:317-908-6624
Mailing Address - Fax:317-641-0434
Practice Address - Street 1:2575 CHASEWAY CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1285
Practice Address - Country:US
Practice Address - Phone:317-908-6624
Practice Address - Fax:317-641-0434
Is Sole Proprietor?:No
Enumeration Date:2014-04-27
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001136A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)