Provider Demographics
NPI:1386965291
Name:SMITH, KIMBLEY GAY (LPC, NCC)
Entity type:Individual
Prefix:MISS
First Name:KIMBLEY
Middle Name:GAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W BELVUE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-1704
Mailing Address - Country:US
Mailing Address - Phone:864-360-6579
Mailing Address - Fax:
Practice Address - Street 1:104 S CALHOUN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-4042
Practice Address - Country:US
Practice Address - Phone:864-283-0637
Practice Address - Fax:864-283-0638
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3676101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)