Provider Demographics
NPI:1932675360
Name:CONYER, KIMBERLY (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CONYER
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 1:121 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-2223
Mailing Address - Country:US
Mailing Address - Phone:757-771-4233
Mailing Address - Fax:
Practice Address - Street 1:5705 LYNNHAVEN PKWY STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-9157
Practice Address - Country:US
Practice Address - Phone:757-524-0167
Practice Address - Fax:757-904-3657
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007854101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional