Provider Demographics
NPI:1639463250
Name:TRAN, KIMBERLY K (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:K
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 RAEFORD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5085
Mailing Address - Country:US
Mailing Address - Phone:910-485-6336
Mailing Address - Fax:
Practice Address - Street 1:1310 RAEFORD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5085
Practice Address - Country:US
Practice Address - Phone:910-485-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4395103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107725Medicaid