Provider Demographics
NPI:1457224362
Name:BOGERT, KIMBERLY (LCMHCA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BOGERT
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7552
Mailing Address - Country:US
Mailing Address - Phone:704-491-1446
Mailing Address - Fax:
Practice Address - Street 1:230 ORANGE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7552
Practice Address - Country:US
Practice Address - Phone:704-491-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA22086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health