Provider Demographics
NPI:1912573791
Name:YARBOROUGH, KIMBERLY WHITAKER (LCSWA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WHITAKER
Last Name:YARBOROUGH
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:W
Other - Last Name:YARBOROUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWA
Mailing Address - Street 1:727 TRAILS END DR
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-4449
Mailing Address - Country:US
Mailing Address - Phone:336-212-1869
Mailing Address - Fax:
Practice Address - Street 1:106 S FOURTH ST STE A
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-2653
Practice Address - Country:US
Practice Address - Phone:919-649-3952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO154731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical