Provider Demographics
NPI:1164913356
Name:WHITE, KIMBLEE (MS/ST)
Entity Type:Individual
Prefix:
First Name:KIMBLEE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS/ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 ERIKA LN
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-8304
Mailing Address - Country:US
Mailing Address - Phone:901-378-2447
Mailing Address - Fax:
Practice Address - Street 1:706 ERIKA LN
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-8304
Practice Address - Country:US
Practice Address - Phone:901-378-2447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health