Provider Information for 1477724573
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Ms. KIMBERLY E SACRA LPC
Other Names:Former Name:Ms. KIMBERLY E MEDLOCK LPCSex: Female
NPI: 1477724573
Last Updated: 2016-12-20
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1477724573 | ||||||||
| Enumeration Date | 2008-03-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3003 N CENTRAL AVE SUITE 200 PHOENIX, AZ 85012-2902 United States Phone: 602-685-6000 | Fax:602-302-7925 | ||||||||
| Primary Practice Address | 1802 E THOMAS RD PHOENIX, AZ 85016-8134 United States Phone: 602-685-6000 | Fax:602-258-6140 | ||||||||
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