Provider Demographics
NPI:1649587221
Name:HALL, KIMBERLY M (MBA, MFTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:MBA, MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 PATE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-6547
Mailing Address - Country:US
Mailing Address - Phone:704-877-5953
Mailing Address - Fax:
Practice Address - Street 1:804 FIELDSTONE RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2732
Practice Address - Country:US
Practice Address - Phone:704-928-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist