Provider Demographics
NPI:1043028434
Name:SAFRANEK, KIMBERLY JANE (LAPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JANE
Last Name:SAFRANEK
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CANAL ST STE 303
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4046
Mailing Address - Country:US
Mailing Address - Phone:912-433-7829
Mailing Address - Fax:912-335-6590
Practice Address - Street 1:138 CANAL ST STE 303
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4046
Practice Address - Country:US
Practice Address - Phone:912-433-7829
Practice Address - Fax:912-335-6590
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010134101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor