Provider Demographics
NPI:1467941492
Name:JOLIVETTE, KIMBERLY SHERRELL
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHERRELL
Last Name:JOLIVETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 LAFOURCHE AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5260
Mailing Address - Country:US
Mailing Address - Phone:337-501-5455
Mailing Address - Fax:
Practice Address - Street 1:3105 LAFOURCHE AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5260
Practice Address - Country:US
Practice Address - Phone:337-501-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health