Active NPI
Melissa Ann Kimball, CRSW
- Addiction (Substance Use Disorder) Counselor
- Manchester, NH
National Provider Identifier
1174178743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 0211
- Practice address
- 60 Rogers St Unit 204
Manchester, NH 03103-5070 - Phone
- (603) 724-4859
- NPI assigned
- Aug 9, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0211 | NH | Primary |
Addresses
Primary practice location
60 Rogers St Unit 204
Manchester, NH 03103-5070
Mailing address
60 Rogers St Unit 204
Manchester, NH 03103-5070
Phone (603) 724-4859
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0211 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0211 | NH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565308800000",
"number": "1174178743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 ROGERS ST UNIT 204",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031035070",
"telephone_number": "603-724-4859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 ROGERS ST UNIT 204",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031035070",
"telephone_number": "603-724-4859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "MELISSA",
"middle_name": "ANN",
"credential": "CRSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-08-09",
"last_updated": "2019-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NH",
"license": "0211",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0211",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manchester, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.