Provider Demographics
NPI:1083384085
Name:COLGAN, KIMBERLY DREW (NCC, LCMHC-A)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:DREW
Last Name:COLGAN
Suffix:
Gender:F
Credentials:NCC, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 N HARRISON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3003
Mailing Address - Country:US
Mailing Address - Phone:919-463-7890
Mailing Address - Fax:919-463-7665
Practice Address - Street 1:1903 N HARRISON AVE STE 100
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3003
Practice Address - Country:US
Practice Address - Phone:919-463-7890
Practice Address - Fax:919-463-7665
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health