Provider Demographics
NPI:1750538591
Name:DALE, KIM F (LPC-MHSP)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:F
Last Name:DALE
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 GEORGE BUCHANAN DR
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-3275
Mailing Address - Country:US
Mailing Address - Phone:615-481-7131
Mailing Address - Fax:
Practice Address - Street 1:2400 CRESTMOOR RD
Practice Address - Street 2:SUITE 210
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2032
Practice Address - Country:US
Practice Address - Phone:615-298-2329
Practice Address - Fax:615-298-1248
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1867101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional