Provider Demographics
NPI:1649568338
Name:ROWAN, KIMBERLY STARR (PHD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:STARR
Last Name:ROWAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13852 GREY FRIARS LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-3938
Mailing Address - Country:US
Mailing Address - Phone:804-464-7763
Mailing Address - Fax:
Practice Address - Street 1:13852 GREY FRIARS LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-3938
Practice Address - Country:US
Practice Address - Phone:804-310-4785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical