Active NPI
Kimberly Ann Haviland, LCSW, CDCI, ADMIN.
- Clinical Social Worker
- Kenai, AK
National Provider Identifier
1881805984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 864
- Practice address
- 11312 Kenai Spur Hwy
Suite 39
Kenai, AK 99611-7754 - Phone
- (907) 395-4106
- Fax
- (907) 283-4236
- NPI assigned
- May 24, 2007
- Last updated
- Jun 18, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 2432 | AK | |
| Clinical Social Worker | 1041C0700X | 864 | AK | Primary |
Addresses
Primary practice location
11312 Kenai Spur Hwy
Suite 39
Kenai, AK 99611-7754
Mailing address
11312 Kenai Spur Hwy
Suite 39
Kenai, AK 99611-7754
Phone (907) 395-4106
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 |
|---|---|---|---|
| 2432 | AK | MD | Addiction (Substance Use Disorder) Counselor |
| 864 | AK | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245283200000",
"number": "1881805984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11312 KENAI SPUR HWY",
"address_2": "SUITE 39",
"city": "KENAI",
"state": "AK",
"postal_code": "996117754",
"telephone_number": "907-395-4106",
"fax_number": "907-283-4236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11312 KENAI SPUR HWY",
"address_2": "SUITE 39",
"city": "KENAI",
"state": "AK",
"postal_code": "996117754",
"telephone_number": "907-395-4106",
"fax_number": "907-283-4236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAVILAND",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"credential": "LCSW, CDCI, ADMIN.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-24",
"last_updated": "2009-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "AK",
"license": "2432",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AK",
"license": "864",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenai, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.