Provider Demographics
NPI:1649987678
Name:ALLEN, KIMBERLY WYNETTE (LCSWA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WYNETTE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:BELLARTHUR
Mailing Address - State:NC
Mailing Address - Zip Code:27811-0461
Mailing Address - Country:US
Mailing Address - Phone:252-367-2694
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 461
Practice Address - Street 2:
Practice Address - City:BELLARTHUR
Practice Address - State:NC
Practice Address - Zip Code:27811-0461
Practice Address - Country:US
Practice Address - Phone:252-367-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0183691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical