Provider Demographics
NPI:1972041408
Name:KILGORE, RICHARD (LPCA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:KILGORE
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 ASHBY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-6196
Mailing Address - Country:US
Mailing Address - Phone:704-323-9125
Mailing Address - Fax:
Practice Address - Street 1:2515 ASHBY DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-6196
Practice Address - Country:US
Practice Address - Phone:704-323-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-04
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional