Provider Demographics
NPI:1417122318
Name:WIMBISH, KEVIN L (LMFT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:WIMBISH
Suffix:
Gender:M
Credentials:LMFT
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 302
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-0302
Mailing Address - Country:US
Mailing Address - Phone:828-329-5487
Mailing Address - Fax:828-676-6259
Practice Address - Street 1:43 FOXDEN DRIVE UNIT 201
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-5640
Practice Address - Country:US
Practice Address - Phone:828-329-5487
Practice Address - Fax:828-676-6259
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1198106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist