Provider Demographics
NPI:1770093973
Name:GAMBLE, KIM JOY
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:JOY
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:JOY
Other - Last Name:ALMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 GRIFFICE MILL RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-8638
Mailing Address - Country:US
Mailing Address - Phone:919-800-9141
Mailing Address - Fax:
Practice Address - Street 1:2000 YONKERS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2258
Practice Address - Country:US
Practice Address - Phone:919-896-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0115481041C0700X
NCLCAS-24176101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical