Provider Demographics
NPI:1720727324
Name:KIMBERLY BLACK COUNSELING & CONSULTING PLLC
Entity Type:Organization
Organization Name:KIMBERLY BLACK COUNSELING & CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS
Authorized Official - Phone:828-206-5876
Mailing Address - Street 1:268 MOCKINGBIRD RD
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-3718
Mailing Address - Country:US
Mailing Address - Phone:828-206-5876
Mailing Address - Fax:
Practice Address - Street 1:268 MOCKINGBIRD RD
Practice Address - Street 2:
Practice Address - City:SWANNANOA
Practice Address - State:NC
Practice Address - Zip Code:28778-3718
Practice Address - Country:US
Practice Address - Phone:828-206-5876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty