Provider Demographics
NPI:1427317866
Name:HARRELL, KIMBERLY S (MED, LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 RIDGE WATER CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5714
Mailing Address - Country:US
Mailing Address - Phone:703-282-4286
Mailing Address - Fax:
Practice Address - Street 1:501 CHURCH ST NE
Practice Address - Street 2:STE. 209
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4734
Practice Address - Country:US
Practice Address - Phone:571-208-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004816101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional