Provider Demographics
NPI:1356972327
Name:EVANS, KIMBERLY ROSE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROSE
Last Name:EVANS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ROSE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 N COOL SPRING ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5134
Mailing Address - Country:US
Mailing Address - Phone:910-500-6606
Mailing Address - Fax:910-208-4081
Practice Address - Street 1:116 N COOL SPRING ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5134
Practice Address - Country:US
Practice Address - Phone:910-500-6606
Practice Address - Fax:910-208-4081
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0213701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical