Provider Demographics
NPI:1285078345
Name:PRETTY, KIMBERLY REYNOLDS (LCAS, LCMHC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:REYNOLDS
Last Name:PRETTY
Suffix:
Gender:F
Credentials:LCAS, LCMHC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7810 PINEVILLE MATTHEWS RD STE 7
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5315
Mailing Address - Country:US
Mailing Address - Phone:980-308-4500
Mailing Address - Fax:980-458-6037
Practice Address - Street 1:7810 PINEVILLE MATTHEWS RD STE 7
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5315
Practice Address - Country:US
Practice Address - Phone:980-308-4500
Practice Address - Fax:980-458-6037
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12100101YP2500X
NC3100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)