Provider Demographics
NPI:1689799157
Name:LANCE, KIM CLAYTON (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:CLAYTON
Last Name:LANCE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 S MARTIN LUTHER KING JR AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-5594
Mailing Address - Country:US
Mailing Address - Phone:704-642-1250
Mailing Address - Fax:704-642-1250
Practice Address - Street 1:1620 S MARTIN LUTHER KING JR AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-5594
Practice Address - Country:US
Practice Address - Phone:704-642-1250
Practice Address - Fax:704-642-1250
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC950106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist