Healthcare Provider Details

I. General information

NPI: 1396794376
Provider Name (Legal Business Name): ELIZABETH A KEMP PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 VANN ROAD STE 100, GRAYSON & ASSOCIATES PC
BIRMINGHAM AL
35235
US

IV. Provider business mailing address

85 SANGERS LN
STAUNTON VA
24401-6712
US

V. Phone/Fax

Practice location:
  • Phone: 205-655-0585
  • Fax: 205-655-0586
Mailing address:
  • Phone: 540-887-3200
  • Fax: 540-887-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number986
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: