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General NPI Number Information
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NPI Number | 1497280606
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Entity Type | Individual
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Provider Name | KIMBERLY ALLEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 22689 HIGHWAY 63
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City | LEAKESVILLE
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State | MS
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Zip | 39451-5662
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Country | US
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Telephone | 601-394-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 33 CHARLESTON WAY
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City | HATTIESBURG
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State | MS
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Zip | 39402-7553
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Country | US
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Telephone | 601-270-0718
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5830
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C6843
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License Number State | MS
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