Healthcare Provider Details

I. General information

NPI: 1790991578
Provider Name (Legal Business Name): KIMBERLY LAHM CHERRY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 WATSON RD SW BUILDING 72 SUITE 101
WASHINGTON DC
20373-0001
US

IV. Provider business mailing address

2225 LOVEDALE LN APT. H
RESTON VA
20191-2362
US

V. Phone/Fax

Practice location:
  • Phone: 202-685-0992
  • Fax: 202-433-0654
Mailing address:
  • Phone: 202-685-0992
  • Fax: 202-433-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000460
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: