Provider Demographics
NPI:1215476585
Name:HENLEY, KIMBERLY CHERYL (LPCA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CHERYL
Last Name:HENLEY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 TECHNOLOGY DR STE K
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7951
Mailing Address - Country:US
Mailing Address - Phone:919-779-6612
Mailing Address - Fax:919-779-7854
Practice Address - Street 1:141 TECHNOLOGY DR STE K
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7951
Practice Address - Country:US
Practice Address - Phone:919-779-6612
Practice Address - Fax:919-779-7854
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-19
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12731101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor