Provider Demographics
NPI:1194359182
Name:KIMBROUGH, MEREDITH LEIGH (MS, LPC)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LEIGH
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E CENTER ST STE 210
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5391
Mailing Address - Country:US
Mailing Address - Phone:513-655-4459
Mailing Address - Fax:
Practice Address - Street 1:31 E CENTER ST STE 210
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5391
Practice Address - Country:US
Practice Address - Phone:513-655-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2304004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health