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General NPI Number Information
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NPI Number | 1619484771
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Entity Type | Individual
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Provider Name | KIMBERLY ANN BALES MA, LPC-I
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Gender | Female
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 3113 HIGHWAY 153 STE G
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City | PIEDMONT
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State | SC
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Zip | 29673-6201
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Country | US
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Telephone | 864-624-2040
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Fax |
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Provider Business Mailing Address
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Address Line | 111 COURT DR
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City | EASLEY
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State | SC
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Zip | 29642-3506
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Country | US
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Telephone | 864-303-0506
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6412
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License Number State | SC
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