Healthcare Provider Details

I. General information

NPI: 1295378529
Provider Name (Legal Business Name): KIMBERLY A MCDUFFIE MA NCC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PAPWORTH AVE STE 209
METAIRIE LA
70005-4923
US

IV. Provider business mailing address

701 PAPWORTH AVE STE 209
METAIRIE LA
70005-4923
US

V. Phone/Fax

Practice location:
  • Phone: 504-495-3019
  • Fax:
Mailing address:
  • Phone: 985-781-0548
  • Fax: 985-781-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: