Provider Demographics
NPI:1982954863
Name:PERRY, KIMBERLY (MS, LPCA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:MS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S STRATFORD RD
Mailing Address - Street 2:SUITE 302C
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3217
Mailing Address - Country:US
Mailing Address - Phone:336-745-5584
Mailing Address - Fax:
Practice Address - Street 1:1100 S STRATFORD RD
Practice Address - Street 2:SUITE 302C
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3217
Practice Address - Country:US
Practice Address - Phone:336-745-5584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9524101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health