Provider Demographics
NPI:1114782448
Name:KIMBROUGH, KATIE (LPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6375
Mailing Address - Country:US
Mailing Address - Phone:760-397-3209
Mailing Address - Fax:
Practice Address - Street 1:337 DRUM POINT RD STE 2B
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6885
Practice Address - Country:US
Practice Address - Phone:760-397-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00992000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional