Provider Demographics
NPI:1275789158
Name:BERRY, KIMBERLY ALLISON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ALLISON
Last Name:BERRY
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 1:187 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-6500
Mailing Address - Country:US
Mailing Address - Phone:334-671-1280
Mailing Address - Fax:334-671-0475
Practice Address - Street 1:187 BELMONT DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-6500
Practice Address - Country:US
Practice Address - Phone:334-671-1280
Practice Address - Fax:334-671-0475
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional