Provider Demographics
NPI:1770968034
Name:HENDRIX, KIMBERLY MCENTIRE (LPC-MHSP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MCENTIRE
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:HAMMONDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KIMBERLY HAMMONDS
Mailing Address - Street 1:2165 LANES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:TN
Mailing Address - Zip Code:38059-5284
Mailing Address - Country:US
Mailing Address - Phone:731-514-1410
Mailing Address - Fax:731-642-6654
Practice Address - Street 1:1365 FLOWERING DOGWOOD LN STE E
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2884
Practice Address - Country:US
Practice Address - Phone:731-514-1410
Practice Address - Fax:731-419-4247
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional