Doctor Name: | KIMBERLY HUNTER SHIDER |
NPI Number: | 1528187457 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 200 Claude Bundrick Rd Kiva Lodge Blythewood, SC - 290169420 |
Business Phone Number: | 8037545478 |
Business Fax Number: | 8037549644 |
Mailing Address: | 204 Green Rose Rd, COLUMBIA |
State: | SC |
Postal Code: | 292299137 |
Phone Number: | 8034467226 |
Fax Number: | |
NPI Enumeration Date: | 03/29/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |