Provider Demographics
NPI:1851860167
Name:WOMBLE, KINSEY OWENS (LCSW)
Entity Type:Individual
Prefix:
First Name:KINSEY
Middle Name:OWENS
Last Name:WOMBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 ANDERSON ST NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-1614
Mailing Address - Country:US
Mailing Address - Phone:252-290-1778
Mailing Address - Fax:
Practice Address - Street 1:4118 STANTONSBURG RD.
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3744
Practice Address - Country:US
Practice Address - Phone:252-290-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0126431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical