Provider Demographics
NPI:1700516010
Name:HEFLIN, KIMBERLY GUIDRY (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GUIDRY
Last Name:HEFLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-1270
Mailing Address - Country:US
Mailing Address - Phone:540-257-7459
Mailing Address - Fax:
Practice Address - Street 1:112 W MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-1270
Practice Address - Country:US
Practice Address - Phone:540-247-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040138101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical