Provider Information for 1316711781
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KIMBERLY WALLACE MASHEGO LICSW-S
Sex: Female
NPI: 1316711781
Last Updated: 2024-08-01
Certification Date: 2024-08-01
Certification Date: 2024-08-01
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1316711781 | ||||||||||||
| Enumeration Date | 2023-11-07 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 212 COLUMBIANA, AL 35051-0212 United States Phone: 205-602-4892 | Fax: | ||||||||||||
| Primary Practice Address | 24809 AL HWY 25 COLUMBIANA, AL 35051 United States Phone: 205-602-4892 | Fax: | ||||||||||||
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