Provider Demographics
NPI:1104334432
Name:SHEPPARD, KIMBERLY (NCC, LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCC
Mailing Address - Street 1:1708 BRANDYWINE RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1704
Mailing Address - Country:US
Mailing Address - Phone:484-221-5543
Mailing Address - Fax:
Practice Address - Street 1:1125 S CEDAR CREST BLVD STE 107
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7903
Practice Address - Country:US
Practice Address - Phone:610-351-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA195101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional