Healthcare Provider Details

I. General information

NPI: 1700147956
Provider Name (Legal Business Name): KIMBERLY ELDRIDGE FORESTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 COLLEGE AVE STE 1
WILKESBORO NC
28697-2700
US

IV. Provider business mailing address

1260 COLLEGE AVE STE 1
WILKESBORO NC
28697-2700
US

V. Phone/Fax

Practice location:
  • Phone: 336-818-0733
  • Fax: 336-818-0734
Mailing address:
  • Phone: 336-818-0733
  • Fax: 336-818-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5261
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: