Provider Demographics
NPI:1457759029
Name:CHOSIE, KIM (LPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:CHOSIE
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 1:114 ADRIS PL
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1997
Mailing Address - Country:US
Mailing Address - Phone:334-671-1677
Mailing Address - Fax:334-792-0657
Practice Address - Street 1:114 ADRIS PL
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1997
Practice Address - Country:US
Practice Address - Phone:334-671-1677
Practice Address - Fax:334-792-0657
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional