Provider Demographics
NPI:1588863435
Name:BARNES, KYLE WILLIAM (EDD LPA LPCS)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WILLIAM
Last Name:BARNES
Suffix:
Gender:M
Credentials:EDD LPA LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 EDGEWATER RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-8661
Mailing Address - Country:US
Mailing Address - Phone:704-244-0288
Mailing Address - Fax:704-498-4390
Practice Address - Street 1:400 MAIN ST W STE 9
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-2752
Practice Address - Country:US
Practice Address - Phone:980-643-1943
Practice Address - Fax:704-498-4390
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3590LPC101YM0800X
NC2058LPA103TC0700X
NC2058103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107413Medicaid