Provider Demographics
NPI:1255150231
Name:JOHNSON, KIMBERLY LIVIDIA (CD, LPC, CBE TRAINEE)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LIVIDIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CD, LPC, CBE TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8468 BLUME PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075
Mailing Address - Country:US
Mailing Address - Phone:704-351-3856
Mailing Address - Fax:
Practice Address - Street 1:8468 BLUME PKWY
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-4507
Practice Address - Country:US
Practice Address - Phone:980-517-6318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula