Provider Demographics
NPI:1669209573
Name:DAVIDSON, KIMBERLIE N (LPC-A)
Entity type:Individual
Prefix:
First Name:KIMBERLIE
Middle Name:N
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N KINGS DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-9459
Mailing Address - Country:US
Mailing Address - Phone:828-273-6234
Mailing Address - Fax:
Practice Address - Street 1:105 N KINGS DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-9459
Practice Address - Country:US
Practice Address - Phone:828-273-6234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10097101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor