Provider Demographics
NPI:1679833065
Name:STANFIELD, KIMBERLY DAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:STANFIELD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:433 E PARKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3111
Mailing Address - Country:US
Mailing Address - Phone:731-287-7289
Mailing Address - Fax:731-287-7385
Practice Address - Street 1:433 E PARKVIEW ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3111
Practice Address - Country:US
Practice Address - Phone:731-287-7289
Practice Address - Fax:731-287-7385
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical