Healthcare Provider Details

I. General information

NPI: 1730653908
Provider Name (Legal Business Name): KIMBERLY FOURNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 07/31/2023
Certification Date: 10/22/2020
Deactivation Date: 08/10/2020
Reactivation Date: 10/21/2020

III. Provider practice location address

1220 E JOPPA RD BLDG B
TOWSON MD
21286-5811
US

IV. Provider business mailing address

4C NORTH AVE STE 432
BEL AIR MD
21014-2330
US

V. Phone/Fax

Practice location:
  • Phone: 410-449-4955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: