Provider Demographics
NPI:1568747848
Name:BISHOP, KIMBERLY H (LPC, MA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:H
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8547 CREEKRISE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1409
Mailing Address - Country:US
Mailing Address - Phone:706-289-6378
Mailing Address - Fax:706-221-0291
Practice Address - Street 1:5650 WHITESVILLE RD STE 109
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3441
Practice Address - Country:US
Practice Address - Phone:706-507-3694
Practice Address - Fax:706-221-0291
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional