Provider Demographics
NPI:1285436386
Name:WHITE, KIMBERLY NOELLE (LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NOELLE
Last Name:WHITE
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 GATEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-7221
Mailing Address - Country:US
Mailing Address - Phone:304-792-0680
Mailing Address - Fax:
Practice Address - Street 1:6505 GATEWOOD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-7221
Practice Address - Country:US
Practice Address - Phone:304-792-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health