Basic Information
| Provider Information | |||||||||
| NPI: | 1477829687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTHONY-BYNG | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 284 EXECUTIVE PARK DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
| FaxNumber: | 7049391173 | ||||||||
| Practice Location | |||||||||
| Address1: | 2129 STATESVILLE BLVD | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281471411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046333616 | ||||||||
| FaxNumber: | 7046368818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2012 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 766 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 906 | NC | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | S-4166 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 133UW | 01 | NC | BCBS | OTHER | 1902003015 | 01 | NC | UNITED BEHAVIORAL HEALTH | OTHER | 6102612 | 05 | NC | MEDICAID | 1902003015 | 01 | NC | HUMANA | OTHER | 537933-000 | 01 | NC | MAGELLAN | OTHER |