Provider Demographics
NPI:1730767468
Name:COUCH, KIMBERLEY (MA)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:COUCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6454 BRIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-2126
Mailing Address - Country:US
Mailing Address - Phone:803-500-5065
Mailing Address - Fax:803-500-5065
Practice Address - Street 1:205 BARNWELL AVE NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3903
Practice Address - Country:US
Practice Address - Phone:839-465-5543
Practice Address - Fax:803-500-5065
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
SD10001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health