Provider Demographics
NPI:1003117011
Name:MCKENNA, KIMBERLY G (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:G
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIMBERY
Other - Middle Name:G
Other - Last Name:KUENY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:715 BEACH RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-2103
Mailing Address - Country:US
Mailing Address - Phone:919-413-5992
Mailing Address - Fax:
Practice Address - Street 1:732 THIMBLE SHOALS BLVD STE 906
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4218
Practice Address - Country:US
Practice Address - Phone:757-525-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-07
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0074771041C0700X
VA09040133741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical