Provider Demographics
NPI:1871540153
Name:FENDER, KIMBERLY L (MA LPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:L
Last Name:FENDER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29071-0372
Mailing Address - Country:US
Mailing Address - Phone:803-470-5525
Mailing Address - Fax:888-892-3184
Practice Address - Street 1:3039 LEAPHART RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3050
Practice Address - Country:US
Practice Address - Phone:803-470-5525
Practice Address - Fax:888-892-3184
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health