Provider Demographics
NPI:1700218179
Name:BRAUDA, KIMBERLY MI-SUK (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MI-SUK
Last Name:BRAUDA
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:STATESBORO PSYCHIATRIC ASSOCIATES
Mailing Address - Street 2:116 HILL POND LANE
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458
Mailing Address - Country:US
Mailing Address - Phone:912-489-1629
Mailing Address - Fax:912-489-1630
Practice Address - Street 1:STATESBORO PSYCHIATRIC ASSOCIATES
Practice Address - Street 2:116 HILL POND LANE
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-489-1629
Practice Address - Fax:912-489-1630
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004820101YP2500X
GALPC004820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional