Provider Demographics
NPI:1083353676
Name:NUNN-CRAWFORD, KIMBERLEY ILENE (LMHC)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ILENE
Last Name:NUNN-CRAWFORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 BLUE MARLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-9811
Mailing Address - Country:US
Mailing Address - Phone:727-418-8338
Mailing Address - Fax:
Practice Address - Street 1:1418 BLUE MARLIN BLVD
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-9811
Practice Address - Country:US
Practice Address - Phone:727-418-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9075101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health