Healthcare Provider Details

I. General information

NPI: 1144835547
Provider Name (Legal Business Name): KIMBERLY ANN EVERARD LCSW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E HARNETT ST
BENSON NC
27504-1706
US

IV. Provider business mailing address

304 E HARNETT ST
BENSON NC
27504-1706
US

V. Phone/Fax

Practice location:
  • Phone: 518-859-4440
  • Fax:
Mailing address:
  • Phone: 518-859-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0137256
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCO16545
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12269
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: