Provider Demographics
NPI:1972847366
Name:KNOELLER, KIM ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:ELAINE
Last Name:KNOELLER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:ELAINE
Other - Last Name:WINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:49 LOOKOUT PT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-9666
Mailing Address - Country:US
Mailing Address - Phone:843-455-2736
Mailing Address - Fax:910-516-1370
Practice Address - Street 1:49 LOOKOUT PT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-9666
Practice Address - Country:US
Practice Address - Phone:843-455-2736
Practice Address - Fax:910-516-1370
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0080681041C0700X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor