Provider Demographics
NPI:1881158467
Name:NGUYEN-DINH, KIMTRINH (LCAS, LPC, BCB, CCS)
Entity type:Individual
Prefix:
First Name:KIMTRINH
Middle Name:
Last Name:NGUYEN-DINH
Suffix:
Gender:F
Credentials:LCAS, LPC, BCB, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 COX AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1817
Mailing Address - Country:US
Mailing Address - Phone:919-432-5105
Mailing Address - Fax:
Practice Address - Street 1:112 COX AVE STE 205
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1817
Practice Address - Country:US
Practice Address - Phone:919-432-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14728101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)