Healthcare Provider Details

I. General information

NPI: 1750224010
Provider Name (Legal Business Name): KIMBERLY CAMPBELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 DURHAM RD STE A-2
WAKE FOREST NC
27587-8793
US

IV. Provider business mailing address

853 DURHAM RD STE A-2
WAKE FOREST NC
27587-8793
US

V. Phone/Fax

Practice location:
  • Phone: 914-584-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA21877
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: