Provider Demographics
NPI:1417126863
Name:ROWE, KIMBERLY JANE (LCPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JANE
Last Name:ROWE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16460 HEATHER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-1008
Mailing Address - Country:US
Mailing Address - Phone:240-520-5452
Mailing Address - Fax:509-752-4845
Practice Address - Street 1:920 W WASHINGTON ST
Practice Address - Street 2:SUITE 206B
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-2800
Practice Address - Country:US
Practice Address - Phone:240-520-5452
Practice Address - Fax:509-752-4845
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD020812400Medicaid