Provider Demographics
NPI:1134181126
Name:ROBINSON, KIMBERLY WOLFE (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WOLFE
Last Name:ROBINSON
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 1:9329 LONGSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5673
Mailing Address - Country:US
Mailing Address - Phone:704-438-9901
Mailing Address - Fax:704-943-4484
Practice Address - Street 1:9329 LONGSTONE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5673
Practice Address - Country:US
Practice Address - Phone:704-438-9901
Practice Address - Fax:704-943-4484
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0049391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106229Medicaid