Provider Demographics
NPI:1255428066
Name:WELBORN, KIMBERLY DAWN I (MA, EDS, LPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:WELBORN
Suffix:I
Gender:F
Credentials:MA, EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-9381
Mailing Address - Country:US
Mailing Address - Phone:336-696-4939
Mailing Address - Fax:
Practice Address - Street 1:118 PEACE ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-4519
Practice Address - Country:US
Practice Address - Phone:336-667-1440
Practice Address - Fax:336-667-1489
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicaid