Provider Demographics
NPI:1407488588
Name:BARRETT, KIMBERLY ALLYSHA (LGPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALLYSHA
Last Name:BARRETT
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6029 BAUMAN DR
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5501
Mailing Address - Country:US
Mailing Address - Phone:240-670-6445
Mailing Address - Fax:
Practice Address - Street 1:1114 BENFIELD BLVD STE G
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2589
Practice Address - Country:US
Practice Address - Phone:410-780-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor