Provider Demographics
NPI:1326188632
Name:KRUEGER, KIMBERLY B (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:B
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 NORTHEAST DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7438
Mailing Address - Country:US
Mailing Address - Phone:704-896-7776
Mailing Address - Fax:704-896-0992
Practice Address - Street 1:903 NORTHEAST DR STE 201
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7438
Practice Address - Country:US
Practice Address - Phone:704-896-7776
Practice Address - Fax:704-896-0992
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0023621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical