Healthcare Provider Details

I. General information

NPI: 1760195556
Provider Name (Legal Business Name): KIMBERLY ANDERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 RIVERSIDE PKWY STE 107
FREDERICKSBURG VA
22406-1094
US

IV. Provider business mailing address

9 RAINWATER LN
FREDERICKSBURG VA
22406-4739
US

V. Phone/Fax

Practice location:
  • Phone: 530-945-8475
  • Fax:
Mailing address:
  • Phone: 530-945-8475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701012059
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: