Basic Information
Provider Information | |||||||||
NPI: | 1801010749 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MORGAN | ||||||||
FirstName: | KIMBERLY | ||||||||
MiddleName: | JONES | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 309 PROGRESS DR | ||||||||
Address2: |   | ||||||||
City: | BURGAW | ||||||||
State: | NC | ||||||||
PostalCode: | 284253280 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9102590668 | ||||||||
FaxNumber: | 9102029966 | ||||||||
Practice Location | |||||||||
Address1: | 309 PROGRESS DR | ||||||||
Address2: |   | ||||||||
City: | BURGAW | ||||||||
State: | NC | ||||||||
PostalCode: | 284253280 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9102594526 | ||||||||
FaxNumber: | 9102029966 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/12/2007 | ||||||||
LastUpdateDate: | 11/26/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 4020 | NC | N |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | S4020 | NC | N |   | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 4020 | NC | N |   | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | S4020 | NC | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.