Healthcare Provider Details

I. General information

NPI: 1841487642
Provider Name (Legal Business Name): KEVIN HAMPTON MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 S HAWTHORNE RD
WINSTON SALEM NC
27103-3784
US

IV. Provider business mailing address

PO BOX 571097
WINSTON SALEM NC
27157-1097
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-0855
  • Fax: 336-716-0822
Mailing address:
  • Phone: 336-716-0855
  • Fax: 336-716-0822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4536
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1527
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: