Provider Demographics
NPI:1578256459
Name:KIMMERLING, KELLY CRAIG (LCMHCA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CRAIG
Last Name:KIMMERLING
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1293 HENDERSONVILLE RD STE 19
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1956
Mailing Address - Country:US
Mailing Address - Phone:828-254-0749
Mailing Address - Fax:
Practice Address - Street 1:1293 HENDERSONVILLE RD STE 19
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1956
Practice Address - Country:US
Practice Address - Phone:828-254-0749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18931101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional