Individual
LESLIE A. KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D, LCP
Contact information
Practice address
1308 SHERWOOD AVE, RICHMOND, VA 23220-1210
(804) 828-3129
(804) 828-9493
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810003386
VA
103TC2200X
Clinical Child & Adolescent Psychologist
0810003386
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010144329 541581185
—
VA
Enumeration date
10/16/2006
Last updated
07/21/2020
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