Provider Demographics
NPI:1811062953
Name:DYSON, KIM ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:ELIZABETH
Last Name:DYSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 GULF CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:THEODORE
Mailing Address - State:AL
Mailing Address - Zip Code:36582-2586
Mailing Address - Country:US
Mailing Address - Phone:251-209-1505
Mailing Address - Fax:251-433-5901
Practice Address - Street 1:5600 GULF CREEK CIR
Practice Address - Street 2:
Practice Address - City:THEODORE
Practice Address - State:AL
Practice Address - Zip Code:36582-2586
Practice Address - Country:US
Practice Address - Phone:251-209-1505
Practice Address - Fax:251-433-5901
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1811062953101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health