Provider Demographics
NPI:1770901118
Name:MINENGER, KIMBERLY (LCPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MINENGER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S. CLINTON STREET MAIL
Mailing Address - Street 2:MAILSTOP CT 05-13
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224
Mailing Address - Country:US
Mailing Address - Phone:443-591-9884
Mailing Address - Fax:
Practice Address - Street 1:1501 S. CLINTON STREET MAIL
Practice Address - Street 2:MAILSTOP CT 05-13
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:443-591-9884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5626101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional