Provider Demographics
NPI:1215301619
Name:MCDONALD, KIMBERLY (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 COOPER ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 COOPER ST STE 102
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-4640
Practice Address - Country:US
Practice Address - Phone:856-845-4447
Practice Address - Fax:856-845-8011
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2017-08-29
Deactivation Date:2016-03-28
Deactivation Code:
Reactivation Date:2017-08-29
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00535600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional