Provider Demographics
NPI:1669769642
Name:KOLK-TOMBERLIN, MEREDITH ANN (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:ANN
Last Name:KOLK-TOMBERLIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1732
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-1732
Mailing Address - Country:US
Mailing Address - Phone:704-892-9490
Mailing Address - Fax:704-892-9433
Practice Address - Street 1:19900 S MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6512
Practice Address - Country:US
Practice Address - Phone:704-892-9490
Practice Address - Fax:704-892-9433
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1138061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical