Healthcare Provider Details

I. General information

NPI: 1780428060
Provider Name (Legal Business Name): KIM HOLTMANN COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 FORESTVILLE RD STE 204
WAKE FOREST NC
27587-9948
US

IV. Provider business mailing address

1021 FORESTVILLE RD STE 204
WAKE FOREST NC
27587-9948
US

V. Phone/Fax

Practice location:
  • Phone: 984-286-4328
  • Fax:
Mailing address:
  • Phone: 919-213-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY HOLTMANN
Title or Position: OWNER
Credential: LCMHC
Phone: 984-286-4328