Healthcare Provider Details

I. General information

NPI: 1871307983
Provider Name (Legal Business Name): KIMBERLY PACK MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MADISON ST
HINTON WV
25951-2524
US

IV. Provider business mailing address

201 MADISON ST
HINTON WV
25951-2524
US

V. Phone/Fax

Practice location:
  • Phone: 304-466-3899
  • Fax:
Mailing address:
  • Phone: 304-466-3899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3267
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: