Basic Information
| Provider Information | |||||||||
| NPI: | 1669054805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ALLESSYA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 CROSSING WATERS WAY | ||||||||
| Address2: | |||||||||
| City: | YORKTOWN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236901001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109883604 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2021 CUNNINGHAM DR | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9999999999 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2021 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 0701009879 | VA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.