Healthcare Provider Details

I. General information

NPI: 1871315325
Provider Name (Legal Business Name): WENDY M KLIMBAL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 W CHURCH ST
JASPER GA
30143-1484
US

IV. Provider business mailing address

644 W CHURCH ST
JASPER GA
30143-1484
US

V. Phone/Fax

Practice location:
  • Phone: 706-299-9285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015192
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: