Provider Demographics
NPI:1578151346
Name:PRICE, KIMBERLY DIONNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DIONNE
Last Name:PRICE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-6702
Mailing Address - Country:US
Mailing Address - Phone:601-307-1812
Mailing Address - Fax:
Practice Address - Street 1:3753 ROSS CLARK CIR STE 4
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2291
Practice Address - Country:US
Practice Address - Phone:601-307-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4255G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker