Healthcare Provider Details

I. General information

NPI: 1972680056
Provider Name (Legal Business Name): KIMBERLY LAJUAN MARABLE LPC, NCC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 MONTCLAIR RD STE 252
BIRMINGHAM AL
35210-2400
US

IV. Provider business mailing address

2749 BENTWOOD DR
BIRMINGHAM AL
35235-2173
US

V. Phone/Fax

Practice location:
  • Phone: 205-567-4718
  • Fax:
Mailing address:
  • Phone: 205-533-8667
  • Fax: 205-533-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2362
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: