Provider Demographics
NPI:1306905526
Name:BARKER, KIMBERLY JAYNE (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JAYNE
Last Name:BARKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5951 GATE POST RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4617
Mailing Address - Country:US
Mailing Address - Phone:704-376-7180
Mailing Address - Fax:704-376-0903
Practice Address - Street 1:2200 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3340
Practice Address - Country:US
Practice Address - Phone:704-376-7180
Practice Address - Fax:704-376-0903
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCOO24611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106488Medicaid