Healthcare Provider Details

I. General information

NPI: 1477311025
Provider Name (Legal Business Name): HOLLIE EASTERLING KIMBROUGH LCASA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 LE PHILLIP CT NE
CONCORD NC
28025-2900
US

IV. Provider business mailing address

219 LE PHILLIP CT NE
CONCORD NC
28025-2900
US

V. Phone/Fax

Practice location:
  • Phone: 336-267-8836
  • Fax:
Mailing address:
  • Phone: 336-267-8836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number29742
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22202
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: