Provider Demographics
NPI:1578545786
Name:MONTGOMERY, KIMBERLY PICHE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:PICHE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3522 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:24064-1980
Mailing Address - Country:US
Mailing Address - Phone:540-977-6300
Mailing Address - Fax:540-977-9523
Practice Address - Street 1:3522 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:24064-1980
Practice Address - Country:US
Practice Address - Phone:540-977-6300
Practice Address - Fax:540-977-9523
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710000503101YA0400X
VA0717000601106H00000X
VA0701002441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005402689Medicaid