Provider Demographics
NPI:1083710917
Name:BIRD, KIMBERLY D (MSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:D
Last Name:BIRD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:EPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:10650 PARK RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8407
Mailing Address - Country:US
Mailing Address - Phone:704-302-8700
Mailing Address - Fax:704-302-8701
Practice Address - Street 1:10650 PARK RD
Practice Address - Street 2:SUITE 420
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8407
Practice Address - Country:US
Practice Address - Phone:704-302-8700
Practice Address - Fax:704-302-8701
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15083OtherHEALTH DEPARTMENT
NC15083OtherHEALTH DEPARTMENT