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General NPI Number Information
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NPI Number | 1932849296
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Entity Type | Individual
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Provider Name | KIMBERLY DAWN DE JONG LPCC
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Gender | Female
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 1212 RAINTREE DR UNIT A2
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City | FORT COLLINS
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State | CO
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Zip | 80526-1832
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Country | US
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Telephone | 970-889-8002
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 RAINTREE DR UNIT A2
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City | FORT COLLINS
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State | CO
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Zip | 80526-1832
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Country | US
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Telephone | 970-889-8002
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPCC.0017932
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License Number State | CO
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