Provider Demographics
NPI:1831770528
Name:DORSEY, KIMBERLY (MA LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PINE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-4803
Mailing Address - Country:US
Mailing Address - Phone:843-450-5754
Mailing Address - Fax:
Practice Address - Street 1:101 PRATHER PARK DR STE D
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-3701
Practice Address - Country:US
Practice Address - Phone:843-212-7340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health