Provider Demographics
NPI:1063241883
Name:CAIN, KIMBERLY (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CAIN
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 TRAILS END RD
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-7616
Mailing Address - Country:US
Mailing Address - Phone:318-581-1876
Mailing Address - Fax:
Practice Address - Street 1:350 FULTON ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-9225
Practice Address - Country:US
Practice Address - Phone:318-581-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4496101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional