Provider Demographics
NPI:1750520581
Name:KINDER, MARY SIMMONS (MA; PLPC; PLCAS; ABD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SIMMONS
Last Name:KINDER
Suffix:
Gender:F
Credentials:MA; PLPC; PLCAS; ABD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2469 CULBRETH RD
Mailing Address - Street 2:
Mailing Address - City:EASTOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28312-7578
Mailing Address - Country:US
Mailing Address - Phone:910-740-4736
Mailing Address - Fax:910-223-1505
Practice Address - Street 1:1500 BRAGG BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4889
Practice Address - Country:US
Practice Address - Phone:910-484-1500
Practice Address - Fax:910-223-1505
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPROVISIONAL101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)