Provider Demographics
NPI:1629165691
Name:RICHARDSON, KIMBERLEE A (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:A
Other - Last Name:CLOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19540 GLEN ELM WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833
Mailing Address - Country:US
Mailing Address - Phone:407-568-9258
Mailing Address - Fax:407-568-9258
Practice Address - Street 1:2813 S HIAWASSEE RD
Practice Address - Street 2:STE 207
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6300
Practice Address - Country:US
Practice Address - Phone:407-492-6271
Practice Address - Fax:407-568-9258
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health