Provider Demographics
NPI:1104055813
Name:BYRD, KIA WEAVER (LPC)
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:WEAVER
Last Name:BYRD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SALEM WOODS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3345
Mailing Address - Country:US
Mailing Address - Phone:888-557-4080
Mailing Address - Fax:919-249-2150
Practice Address - Street 1:808 SALEM WOODS DR STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3345
Practice Address - Country:US
Practice Address - Phone:888-557-4080
Practice Address - Fax:919-249-2150
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104269Medicaid