Provider Demographics
NPI:1932657723
Name:STEPHENS-COHEN, KIMBERLY WATKINS (BASS, CADCII, MATC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:WATKINS
Last Name:STEPHENS-COHEN
Suffix:
Gender:F
Credentials:BASS, CADCII, MATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1504
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-1504
Mailing Address - Country:US
Mailing Address - Phone:423-313-6868
Mailing Address - Fax:
Practice Address - Street 1:4083 CLOUD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-8411
Practice Address - Country:US
Practice Address - Phone:706-820-6087
Practice Address - Fax:706-956-8171
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA814101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)