Provider Demographics
NPI:1003166950
Name:SPOONER, KIM CHRISTINE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:CHRISTINE
Last Name:SPOONER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:CHRISTINE
Other - Last Name:SPOONER-CORREIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, M A
Mailing Address - Street 1:1397 ROCKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1934
Mailing Address - Country:US
Mailing Address - Phone:774-328-8718
Mailing Address - Fax:774-202-2826
Practice Address - Street 1:1397 ROCKDALE AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-1934
Practice Address - Country:US
Practice Address - Phone:774-328-8718
Practice Address - Fax:774-202-2826
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health