Provider Demographics
NPI:1912734260
Name:GREENE, KIMBERLY RAYE (LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RAYE
Last Name:GREENE
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 1:7113 THREE CHOPT RD STE 210
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3644
Mailing Address - Country:US
Mailing Address - Phone:804-741-2333
Mailing Address - Fax:
Practice Address - Street 1:7113 THREE CHOPT RD STE 210
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3644
Practice Address - Country:US
Practice Address - Phone:804-741-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health