Provider Demographics
NPI:1881922995
Name:EVANS, KIMBERLY HINTON (MA, EDM, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:HINTON
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA, EDM, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 RAEFORD ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5086
Mailing Address - Country:US
Mailing Address - Phone:910-920-0572
Mailing Address - Fax:
Practice Address - Street 1:1310 RAEFORD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5085
Practice Address - Country:US
Practice Address - Phone:910-920-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011168101YM0800X
NC7541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health