Provider Demographics
NPI:1811310899
Name:HARRELSON, KIMBERLY BLANCHE
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:BLANCHE
Last Name:HARRELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:HARRELSON
Other - Last Name:LESESNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301-A PALMETTO PARK BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072
Mailing Address - Country:US
Mailing Address - Phone:803-359-3545
Mailing Address - Fax:803-359-2111
Practice Address - Street 1:301-A PALMETTO PARK BOULEVARD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072
Practice Address - Country:US
Practice Address - Phone:803-359-3545
Practice Address - Fax:803-359-2111
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC740192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry