Provider Demographics
NPI:1467609743
Name:MCGREW, KIMBERLY BOLEN (MA, LPA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BOLEN
Last Name:MCGREW
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ROSE
Other - Last Name:BOLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPA
Mailing Address - Street 1:7212 CULLODEN CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7265
Mailing Address - Country:US
Mailing Address - Phone:910-512-2890
Mailing Address - Fax:910-821-8447
Practice Address - Street 1:1213 CULBRETH DR
Practice Address - Street 2:SUITE 125
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3639
Practice Address - Country:US
Practice Address - Phone:910-509-7147
Practice Address - Fax:910-821-8447
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3605103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist