Provider Demographics
NPI:1720123730
Name:MUNSON, KIM RANDALL (LPC)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:RANDALL
Last Name:MUNSON
Suffix:
Gender:M
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:PO BOX 7522
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-7522
Mailing Address - Country:US
Mailing Address - Phone:540-371-2610
Mailing Address - Fax:
Practice Address - Street 1:2300 FALL HILL AVE STE 213
Practice Address - Street 2:FREDERICKSBURG
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3342
Practice Address - Country:US
Practice Address - Phone:540-371-2610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002073101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor