MEDICARE: KIMBERLY K JONES - KARISMA CONSULTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	0904004832	VA
2	251S00000X	Community/Behavioral Health Agency	0904004832	VA

General Provider Information

NPI Number	:	1538382197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY K JONES - KARISMA CONSULTING

Provider Business Mailing Address
First Line	:	21811 COX RD
Second Line	:	P O BOX 365
City	:	SUTHERLAND
State	:	VA
Zip	:	23885-9433
Country	:	US
Telephone Number	:	804-721-4149
Fax Number	:	804-733-4668

Provider Business Practice Location Address
First Line	:	26018 COX RD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-6566
Country	:	US
Telephone Number	:	804-862-4242
Fax Number	:	804-733-4668

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	MS. KIMBERLY KAY JONES
Credential	:	LCSW
Telephone Number	:	804-862-4242

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	06/24/2008

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