Provider Demographics
NPI:1912377615
Name:CLEMENS, KIMBERLY SUN YUNG (LCPC, LCPAT, ATR-BC)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:SUN YUNG
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:LCPC, LCPAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 TIDEWATER COLONY DR STE 1A
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2102
Mailing Address - Country:US
Mailing Address - Phone:410-995-8737
Mailing Address - Fax:
Practice Address - Street 1:2007 TIDEWATER COLONY DR STE 1A
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2102
Practice Address - Country:US
Practice Address - Phone:410-294-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6602101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional