Provider Demographics
NPI:1295072429
Name:MCGREGOR, KIMBERLY DEON (LCAS, CCS-I)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DEON
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:LCAS, CCS-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SAINT MATTHEWS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7840
Mailing Address - Country:US
Mailing Address - Phone:910-551-4461
Mailing Address - Fax:
Practice Address - Street 1:139 PINEHURST AVE STE A
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7099
Practice Address - Country:US
Practice Address - Phone:910-551-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2926-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)