Provider Demographics
NPI:1023057213
Name:BROWN, KIMBERLY ELAINE (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2366 STEVENSON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-7138
Mailing Address - Country:US
Mailing Address - Phone:904-673-6760
Mailing Address - Fax:904-371-4958
Practice Address - Street 1:2366 STEVENSON DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-7138
Practice Address - Country:US
Practice Address - Phone:904-673-6760
Practice Address - Fax:904-371-4958
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical