Healthcare Provider Details

I. General information

NPI: 1821445149
Provider Name (Legal Business Name): KIMBERLY MARIE BEALL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 OAK HILL LN
SMITHFIELD VA
23430-6294
US

IV. Provider business mailing address

113 OAK HILL LN
SMITHFIELD VA
23430-6294
US

V. Phone/Fax

Practice location:
  • Phone: 267-392-6008
  • Fax:
Mailing address:
  • Phone: 267-392-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009086
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011305
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: