Provider Demographics
NPI:1144781345
Name:PANTONE, KIMBERLY ROSS (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ROSS
Last Name:PANTONE
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 1:4400 HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-4525
Mailing Address - Country:US
Mailing Address - Phone:757-509-2139
Mailing Address - Fax:
Practice Address - Street 1:297 INDEPENDENCE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2911
Practice Address - Country:US
Practice Address - Phone:757-385-0850
Practice Address - Fax:757-473-2136
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA186152472Medicaid