Provider Demographics
NPI:1245265511
Name:HART, KIMBERLY (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S BRADDOCK ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4043
Mailing Address - Country:US
Mailing Address - Phone:540-662-8368
Mailing Address - Fax:540-662-2872
Practice Address - Street 1:214 S BRADDOCK ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4043
Practice Address - Country:US
Practice Address - Phone:540-662-8368
Practice Address - Fax:540-662-2872
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003655101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0007560835OtherAETNA
VA146513OtherANTHEM BCBS
VA085152MOtherCOMMUNITY HEALTH