Provider Demographics
NPI:1275648479
Name:WHITEHURST, KIM TYLER (LPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:TYLER
Last Name:WHITEHURST
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 N POINT BLVD
Mailing Address - Street 2:SUITE 231
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3262
Mailing Address - Country:US
Mailing Address - Phone:336-896-0065
Mailing Address - Fax:336-896-0710
Practice Address - Street 1:8025 N POINT BLVD
Practice Address - Street 2:SUITE 231
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3262
Practice Address - Country:US
Practice Address - Phone:336-896-0065
Practice Address - Fax:336-896-0710
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1001101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional