Provider Demographics
NPI:1821639337
Name:MCLEOD, KIM MARIE
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIE
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 TRIPLE CROWN CIR APT 305
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3071
Mailing Address - Country:US
Mailing Address - Phone:757-685-2977
Mailing Address - Fax:
Practice Address - Street 1:3131 AZALEA GARDEN RD STE B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2303
Practice Address - Country:US
Practice Address - Phone:757-271-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health