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General NPI Number Information
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NPI Number | 1396337663
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Entity Type | Individual
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Provider Name | KIMBERLY ANN CALDWELL LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 245 WESTLAKE RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-4865
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Country | US
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Telephone | 919-867-4417
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Fax |
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Provider Business Mailing Address
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Address Line | 6548 PACIFIC AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-6548
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Country | US
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Telephone | 984-227-3532
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | A15423
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License Number State | NC
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