=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245073626
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYDKIMYLE CONSULTING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2024
-----------------------------------------------------
Last Update Date | 06/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 W 5TH ST
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28202-1408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-412-2039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1815 WASHINGTON AVE
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28216-5429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-650-6707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/FOUNDER
-----------------------------------------------------
Name | MRS. KIMBERLY DIANE MCGREGOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-650-6707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------