Provider Demographics
NPI:1912925173
Name:KIMBALL, MARY ANN BARNES
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:BARNES
Last Name:KIMBALL
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 1:710 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-3002
Mailing Address - Country:US
Mailing Address - Phone:919-929-2948
Mailing Address - Fax:919-968-1088
Practice Address - Street 1:710 CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-3002
Practice Address - Country:US
Practice Address - Phone:919-929-2948
Practice Address - Fax:919-968-1088
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0007171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical