Provider Demographics
NPI:1144865973
Name:HANSON, KIMBERLY S (LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:HANSON
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 1:669 MARINA DR STE B6
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8120
Mailing Address - Country:US
Mailing Address - Phone:843-814-4429
Mailing Address - Fax:
Practice Address - Street 1:669 MARINA DR STE B6
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-8120
Practice Address - Country:US
Practice Address - Phone:843-814-4429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7060101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional