Provider Demographics
NPI:1720132483
Name:KIMBROUGH, LINDA HUDSON (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:HUDSON
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,LPC
Mailing Address - Street 1:743 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-1825
Mailing Address - Country:US
Mailing Address - Phone:678-363-3561
Mailing Address - Fax:678-363-3561
Practice Address - Street 1:743 THOMAS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-1825
Practice Address - Country:US
Practice Address - Phone:678-363-3561
Practice Address - Fax:678-363-3561
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional