Provider Demographics
NPI:1427890490
Name:HANEY, KIMBERLY IEISHA (LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:IEISHA
Last Name:HANEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 OLD OYSTER POINT RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-7131
Mailing Address - Country:US
Mailing Address - Phone:757-927-8292
Mailing Address - Fax:
Practice Address - Street 1:710 DENBIGH BLVD STE 6A1
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4400
Practice Address - Country:US
Practice Address - Phone:757-525-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional