Provider Demographics
NPI:1104192954
Name:WHITCHARD, KIMBERLY (PHD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WHITCHARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 GARDEN CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7327
Mailing Address - Country:US
Mailing Address - Phone:251-979-5538
Mailing Address - Fax:
Practice Address - Street 1:22394 MIFLIN RD STE 201B
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-9593
Practice Address - Country:US
Practice Address - Phone:251-943-6213
Practice Address - Fax:251-943-6213
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11213103T00000X
AL850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist