Provider Demographics
NPI:1124262274
Name:SORRELL, KIMBERLY MOODY (LCAS)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MOODY
Last Name:SORRELL
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3285
Mailing Address - Street 2:
Mailing Address - City:DREXEL
Mailing Address - State:NC
Mailing Address - Zip Code:28619-3285
Mailing Address - Country:US
Mailing Address - Phone:828-432-7649
Mailing Address - Fax:
Practice Address - Street 1:203 WHITE ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3417
Practice Address - Country:US
Practice Address - Phone:828-433-1221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)