Healthcare Provider Details

I. General information

NPI: 1871724641
Provider Name (Legal Business Name): KIMBERLEY JANE FOURNIER-JACQUES LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 WRIGHTSVILLE AVE STE 110
WILMINGTON NC
28403-6251
US

IV. Provider business mailing address

233 RACINE DR UNIT 9
WILMINGTON NC
28403-1946
US

V. Phone/Fax

Practice location:
  • Phone: 910-799-6162
  • Fax:
Mailing address:
  • Phone: 207-783-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023883
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: