Provider Demographics
NPI:1457592578
Name:HAMRICK, KIMBERLY LOGAN (MED, LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOGAN
Last Name:HAMRICK
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 QUAIL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-5125
Mailing Address - Country:US
Mailing Address - Phone:704-473-1164
Mailing Address - Fax:
Practice Address - Street 1:3719 LATROBE DR
Practice Address - Street 2:SUITE 830
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4861
Practice Address - Country:US
Practice Address - Phone:704-473-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6875101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor