Provider Demographics
NPI:1508170838
Name:HERRING, KIMBERLY CARPENTER (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CARPENTER
Last Name:HERRING
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 SW STATE ROAD 47
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-0433
Mailing Address - Country:US
Mailing Address - Phone:386-397-0696
Mailing Address - Fax:386-754-1325
Practice Address - Street 1:871 SW STATE ROAD 47
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-0433
Practice Address - Country:US
Practice Address - Phone:386-397-0696
Practice Address - Fax:386-754-1325
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW54911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical