Provider Demographics
NPI:1134634736
Name:MONDEZIE, KIMBERLY (LPC, CSAC, CRC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MONDEZIE
Suffix:
Gender:
Credentials:LPC, CSAC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 MAPLE LEAF LN
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-2669
Mailing Address - Country:US
Mailing Address - Phone:804-601-4603
Mailing Address - Fax:
Practice Address - Street 1:7008 MAPLE LEAF LN
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-2669
Practice Address - Country:US
Practice Address - Phone:804-439-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102851101YA0400X
VA00117448225C00000X
VA0701006952101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor