Healthcare Provider Details

I. General information

NPI: 1467104174
Provider Name (Legal Business Name): KIMBERLY LORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVENUE
BILOXI MS
39531
US

IV. Provider business mailing address

270 TRACE COLONY PARK, STE B
RIDGELAND MS
39157
US

V. Phone/Fax

Practice location:
  • Phone: 228-523-5000
  • Fax:
Mailing address:
  • Phone: 228-678-1989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC8440
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: