Provider Demographics
NPI:1003910712
Name:HENDRICK, KIMBERLEY STROUD (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:STROUD
Last Name:HENDRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2623
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-2623
Mailing Address - Country:US
Mailing Address - Phone:615-449-9611
Mailing Address - Fax:615-453-7051
Practice Address - Street 1:440 PARK AVE.
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-449-9611
Practice Address - Fax:615-453-7051
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW33581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3697247Medicare ID - Type Unspecified