Provider Demographics
NPI:1639367220
Name:CUTHRELL, KIMBERLY MICHELE
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MICHELE
Last Name:CUTHRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 MARTIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4931
Mailing Address - Country:US
Mailing Address - Phone:336-287-7929
Mailing Address - Fax:
Practice Address - Street 1:1510 MARTIN ST STE 103
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4931
Practice Address - Country:US
Practice Address - Phone:336-287-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103705Medicaid