Provider Demographics
NPI:1588357453
Name:HUMBERT, KIMBERLY LAJUAN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LAJUAN
Last Name:HUMBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-2907
Mailing Address - Country:US
Mailing Address - Phone:251-753-2832
Mailing Address - Fax:
Practice Address - Street 1:32 TACON ST STE C
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3138
Practice Address - Country:US
Practice Address - Phone:251-298-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC4014A101YM0800X
ALLPC05267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health