Provider Demographics
NPI:1407610520
Name:GADSON, KIMBERLY NMN (LPCA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NMN
Last Name:GADSON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BAYLOR DR STE 113
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8905
Mailing Address - Country:US
Mailing Address - Phone:843-707-7046
Mailing Address - Fax:
Practice Address - Street 1:80 BAYLOR DR STE 113
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8905
Practice Address - Country:US
Practice Address - Phone:843-707-7046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional