| Doctor Name: | KIMBERLY JO ELIAS |
| NPI Number: | 1023320918 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 0718000230 |
| Business Practice Address: | 406 Chatham Square Office Park Suite 102 Fredericksburg, VA - 224052585 |
| Business Phone Number: | 9078311243 |
| Business Fax Number: | 5403736266 |
| Mailing Address: | 1301 Dunes St, Apt 101 FREDERICKSBURG |
| State: | VA |
| Postal Code: | 224015027 |
| Phone Number: | 9078311243 |
| Fax Number: | 5403736266 |
| NPI Enumeration Date: | 07/08/2010 |
| NPI Last Update Date: | 03/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 0718000230 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |