Provider Demographics
NPI:1134539364
Name:KIMBALL COUNSELING PC
Entity type:Organization
Organization Name:KIMBALL COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:PENNEY
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CASAC
Authorized Official - Phone:828-246-6100
Mailing Address - Street 1:1077 FERN TRL
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-9706
Mailing Address - Country:US
Mailing Address - Phone:828-246-6100
Mailing Address - Fax:828-246-6100
Practice Address - Street 1:258 N MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3812
Practice Address - Country:US
Practice Address - Phone:828-246-6100
Practice Address - Fax:828-246-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC008384251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health