Provider Demographics
NPI:1801407275
Name:JENKINS-RICHARDSON, KIMBERLY (PHD, LPC-S, NCC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:JENKINS-RICHARDSON
Suffix:
Gender:F
Credentials:PHD, LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 LENOX DR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-7446
Mailing Address - Country:US
Mailing Address - Phone:205-799-1274
Mailing Address - Fax:
Practice Address - Street 1:2032 LENOX DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-7446
Practice Address - Country:US
Practice Address - Phone:205-799-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AL2926101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health