Provider Demographics
NPI:1811087919
Name:HERRING, KIMBERLY ANN (MA, LPA, LPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:HERRING
Suffix:
Gender:F
Credentials:MA, LPA, LPC
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:RUEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPA, LPC
Mailing Address - Street 1:3411 BRUSHY HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-5662
Mailing Address - Country:US
Mailing Address - Phone:910-426-6920
Mailing Address - Fax:
Practice Address - Street 1:901 ARSENAL AVE STE 202E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5398
Practice Address - Country:US
Practice Address - Phone:910-323-3368
Practice Address - Fax:910-486-7000
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4067 LPC101YP2500X
NC1769103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107002Medicaid
NC13235OtherBUE CROSS BLUE SHIELD