Healthcare Provider Details

I. General information

NPI: 1275258790
Provider Name (Legal Business Name): KYMBERLI DIAMOND LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10003 COURTVIEW LN
CHESTERFIELD VA
23832-6682
US

IV. Provider business mailing address

5400 WILLOW GROVE RD
CHESTERFIELD VA
23832-9282
US

V. Phone/Fax

Practice location:
  • Phone: 804-731-6208
  • Fax:
Mailing address:
  • Phone: 804-687-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011615
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: