Healthcare Provider Details

I. General information

NPI: 1790689602
Provider Name (Legal Business Name): LORI KIKER-CHAMBERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CONCORD AVE
MONROE NC
28110-2907
US

IV. Provider business mailing address

3536 TARLTON MILL RD
MARSHVILLE NC
28103-9636
US

V. Phone/Fax

Practice location:
  • Phone: 980-500-9138
  • Fax:
Mailing address:
  • Phone: 704-995-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23567
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: