Provider Demographics
NPI:1598154668
Name:KIMBERLY CARPENTER HERRING, L.L.C.
Entity Type:Organization
Organization Name:KIMBERLY CARPENTER HERRING, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:CARPENTER
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:386-397-0696
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:386-961-9616
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:386-961-9616
Practice Address - Fax:386-754-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 54911041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty