Provider Demographics
NPI:1356708994
Name:KIMBERLY OWEN
Entity type:Organization
Organization Name:KIMBERLY OWEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-604-9249
Mailing Address - Street 1:17830 STATESVILLE RD
Mailing Address - Street 2:SUITE235
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-9173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17830 STATESVILLE RD
Practice Address - Street 2:SUITE235
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-9173
Practice Address - Country:US
Practice Address - Phone:704-604-9249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health