Individual
MS. KIMBERLY LISLE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
323 ROLAND RD, JASPER, GA 30143-5336
(706) 253-1112
(706) 253-1120
Mailing address
323 ROLAND RD, JASPER, GA 30143-5336
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC003867
GA
Other
Enumeration date
05/21/2012
Last updated
05/21/2012
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