Kim Richard Dismukes, LPC
Individual provider Active NPI Professional Counselor · Dotham, AL
NPI 1417064320 · NPPES record last updated Jan 24, 2019
Key facts
- NPI
- 1417064320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 459 (AL)
- Practice address
- 100 Westside Dr
Dotham, AL 36303 - Phone
- (334) 793-2237
- Fax
- (334) 712-6256
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 459 | AL | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chrysalis, a Home for Girls, Inc. | Past | Accepting new patients | |
| Milestones Psychology and Therapy Inc | Professional | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 459 | AL | Yes |
Addresses
Primary practice location
100 Westside Dr
Dotham, AL 36303
Mailing address
100 Westside Dr
Dothan, AL 36303-1908
Phone (334) 793-2237
Other providers in Dotham, AL
All providers in Dotham, AL · Professional Counselor in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.