Healthcare Provider Details

I. General information

NPI: 1700516010
Provider Name (Legal Business Name): KIMBERLY GUIDRY HEFLIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W MAIN ST STE 202
BERRYVILLE VA
22611-1270
US

IV. Provider business mailing address

112 W MAIN ST STE 202
BERRYVILLE VA
22611-1270
US

V. Phone/Fax

Practice location:
  • Phone: 540-247-7459
  • Fax:
Mailing address:
  • Phone: 540-257-7459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013810
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: