Provider Demographics
NPI:1710611165
Name:BURTON, KIMBERLY L (LCSWA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:BURTON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:LATRICE
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:813 GREEN OAKS ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-4894
Mailing Address - Country:US
Mailing Address - Phone:336-259-3955
Mailing Address - Fax:
Practice Address - Street 1:235 E RALEIGH ST
Practice Address - Street 2:
Practice Address - City:SILER CITY
Practice Address - State:NC
Practice Address - Zip Code:27344-3552
Practice Address - Country:US
Practice Address - Phone:919-704-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0177461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical