Provider Demographics
NPI:1699281832
Name:TOWNES, KIMBERLY ALEXANDER (CSAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALEXANDER
Last Name:TOWNES
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 HOPE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4228
Mailing Address - Country:US
Mailing Address - Phone:910-779-0454
Mailing Address - Fax:910-491-0833
Practice Address - Street 1:2212 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4228
Practice Address - Country:US
Practice Address - Phone:910-779-0454
Practice Address - Fax:910-491-0833
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCSAC-24237101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)