Provider Demographics
NPI:1740830280
Name:BEGA, KIMBERLY ANN (MA, NCC, LBS, LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:BEGA
Suffix:
Gender:F
Credentials:MA, NCC, LBS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11835 HAZEL CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-1223
Mailing Address - Country:US
Mailing Address - Phone:703-368-7995
Mailing Address - Fax:
Practice Address - Street 1:20 ROCK POINTE LN STE 201
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2680
Practice Address - Country:US
Practice Address - Phone:703-659-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011169101YP2500X
VA0701008599101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional