Provider Demographics
NPI:1780731513
Name:WILSON, KIMBERLY (LPCC,NCC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 RUSSELL RD
Mailing Address - Street 2:SUITE 93
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1054
Mailing Address - Country:US
Mailing Address - Phone:270-384-1736
Mailing Address - Fax:270-384-1734
Practice Address - Street 1:933 RUSSELL RD
Practice Address - Street 2:SUITE 93
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1054
Practice Address - Country:US
Practice Address - Phone:270-384-1736
Practice Address - Fax:270-384-1734
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health