Provider Demographics
NPI:1811025042
Name:MCINTYRE, KIMBERLY BETH (MS, LCMHCS)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BETH
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MS, LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 TRAFALGAR RD
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9854
Mailing Address - Country:US
Mailing Address - Phone:252-717-9917
Mailing Address - Fax:
Practice Address - Street 1:300 E ARLINGTON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5037
Practice Address - Country:US
Practice Address - Phone:252-717-9917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138FAOtherBCBS
NC6102136Medicaid