Provider Demographics
NPI:1720656820
Name:SANTANA, KIMBERLY (LPC, LCADC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1370
Mailing Address - Country:US
Mailing Address - Phone:609-240-5152
Mailing Address - Fax:
Practice Address - Street 1:3 3RD ST
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1370
Practice Address - Country:US
Practice Address - Phone:609-240-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00749600101YM0800X
NJ37LC00330300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health