Provider Demographics
NPI:1518219351
Name:WOODMANSEE-DOPSON, KIMBERLY JEAN (LCPC, MAC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:WOODMANSEE-DOPSON
Suffix:
Gender:F
Credentials:LCPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 RIVER VISTA PL STE 201
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3060
Mailing Address - Country:US
Mailing Address - Phone:208-242-4370
Mailing Address - Fax:208-734-3534
Practice Address - Street 1:808 EASTLAND DR
Practice Address - Street 2:SUITE D
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6813
Practice Address - Country:US
Practice Address - Phone:208-539-5090
Practice Address - Fax:208-878-3424
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4822101YP2500X
IDLCPC4822101YP2500X
IDMAC23903101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)