Provider Demographics
NPI:1285070433
Name:RODGERS, KIMBERLY (LPCA, NCC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 MONROE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7743
Mailing Address - Country:US
Mailing Address - Phone:804-839-9550
Mailing Address - Fax:
Practice Address - Street 1:222 EMERSON AVE
Practice Address - Street 2:APT 19
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4382
Practice Address - Country:US
Practice Address - Phone:804-839-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health