Provider Demographics
NPI:1821845256
Name:VANTERPOOL, KIMAYA KATERA
Entity type:Individual
Prefix:
First Name:KIMAYA
Middle Name:KATERA
Last Name:VANTERPOOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 MILLS PARK DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3593
Mailing Address - Country:US
Mailing Address - Phone:803-366-4848
Mailing Address - Fax:
Practice Address - Street 1:2670 MILLS PARK DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3593
Practice Address - Country:US
Practice Address - Phone:803-366-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health