Healthcare Provider Details

I. General information

NPI: 1780340331
Provider Name (Legal Business Name): KIMBRELIA STOKES MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 SUNNYVALE DR
JACKSON MS
39211-4844
US

IV. Provider business mailing address

5035 SUNNYVALE DR
JACKSON MS
39211-4844
US

V. Phone/Fax

Practice location:
  • Phone: 769-232-9278
  • Fax:
Mailing address:
  • Phone: 769-232-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2712
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: