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General NPI Number Information
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NPI Number | 1578151346
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Entity Type | Individual
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Provider Name | KIMBERLY DIONNE PRICE LMSW
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Gender | Female
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 3753 ROSS CLARK CIR STE 4
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City | DOTHAN
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State | AL
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Zip | 36303-2291
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Country | US
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Telephone | 601-307-1812
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Fax |
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Provider Business Mailing Address
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Address Line | 119 MADISON AVE
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City | ENTERPRISE
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State | AL
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Zip | 36330-6702
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Country | US
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Telephone | 601-307-1812
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 4255G
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License Number State | AL
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