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General NPI Number Information
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NPI Number | 1518219351
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Entity Type | Individual
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Provider Name | KIMBERLY JEAN WOODMANSEE-DOPSON LCPC, MAC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 808 EASTLAND DR SUITE D
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City | TWIN FALLS
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State | ID
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Zip | 83301-6813
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Country | US
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Telephone | 208-539-5090
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Fax | 208-878-3424
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Provider Business Mailing Address
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Address Line | 139 RIVER VISTA PL STE 201
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City | TWIN FALLS
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State | ID
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Zip | 83301-3060
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Country | US
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Telephone | 208-242-4370
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Fax | 208-734-3534
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4822
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC4822
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MAC23903
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License Number State | ID
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