| Doctor Name: | MICHELLE KIMMERLY |
| NPI Number: | 1063790988 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | PC005962 |
| Business Practice Address: | 219 W Lancaster Ave Paoli, PA - 193011791 |
| Business Phone Number: | 6106446464 |
| Business Fax Number: | 6106444066 |
| Mailing Address: | 1440 Russell Rd, PAOLI |
| State: | PA |
| Postal Code: | 193011236 |
| Phone Number: | 6106446464 |
| Fax Number: | 6106444066 |
| NPI Enumeration Date: | 07/26/2011 |
| NPI Last Update Date: | 07/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | PC005962 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |