Provider Demographics
NPI:1780058651
Name:LAMBERT, KYLIE POLZER (LCSW, LCAS-A)
Entity type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:POLZER
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:LCSW, LCAS-A
Other - Prefix:MISS
Other - First Name:KYLIE
Other - Middle Name:KATHLEEN
Other - Last Name:POLZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-A, LCAS-A
Mailing Address - Street 1:10410 SABLEWOOD DR
Mailing Address - Street 2:UNIT 105
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7917
Mailing Address - Country:US
Mailing Address - Phone:610-844-8224
Mailing Address - Fax:
Practice Address - Street 1:1330 SAINT MARYS ST STE 340
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-3334
Practice Address - Country:US
Practice Address - Phone:919-229-9834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21771101YA0400X
NCC0111451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)