Provider Demographics
NPI:1619340106
Name:BOWERS, KIMBERLY AUTUMN (LCSW, LCAS, CSI)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:AUTUMN
Last Name:BOWERS
Suffix:
Gender:F
Credentials:LCSW, LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:940 W LEBANON ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2222
Practice Address - Country:US
Practice Address - Phone:336-783-6919
Practice Address - Fax:336-983-6923
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20443101YA0400X
NCC0111511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)