Provider Demographics
NPI:1346778743
Name:STIRES, KIMBERLEY MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:MARIE
Last Name:STIRES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:
Other - Last Name:WILLYARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:116 COLES ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1963
Mailing Address - Country:US
Mailing Address - Phone:201-252-7121
Mailing Address - Fax:
Practice Address - Street 1:101 HUDSON ST FL 21
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3929
Practice Address - Country:US
Practice Address - Phone:201-252-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00589300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health