Provider Demographics
NPI:1528711512
Name:KIMBRO, ANTHONY GLENN (LPC PRE-LICENSE)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:GLENN
Last Name:KIMBRO
Suffix:
Gender:M
Credentials:LPC PRE-LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 ASHE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW JOHNSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37134-9681
Mailing Address - Country:US
Mailing Address - Phone:931-412-3258
Mailing Address - Fax:
Practice Address - Street 1:795 HOLLY LN
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-3392
Practice Address - Country:US
Practice Address - Phone:931-296-9813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health