Healthcare Provider Details

I. General information

NPI: 1760477855
Provider Name (Legal Business Name): KIMBERLY B BEBEAU L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 HAIRSTON ST
DANVILLE VA
24540-4137
US

IV. Provider business mailing address

1045 MAIN STREET, SUITE 5 COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
DANVILLE VA
24541-1800
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-0456
  • Fax: 434-793-4201
Mailing address:
  • Phone: 434-792-2277
  • Fax: 434-792-2279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003052
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: