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1609208875 NPI number — KIMBERLY ANN SMITLEY M.ED, NCC, LPCA

NPI Number: 1609208875
Health Care Provider/Practitioner: KIMBERLY ANN SMITLEY M.ED, NCC, LPCA

Information about “1609208875” NPI (KIMBERLY ANN SMITLEY M.ED, NCC, LPCA) exists in 1609208875 in HTML format HTML  |  1609208875 in plain Text format TXT  |  1609208875 in PDF (Portable Document Format) PDF  |  1609208875 in an XML format XML  formats.

NPI Number : 1609208875 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609208875",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SMITLEY",
    "FirstName": "KIMBERLY",
    "MiddleName": "ANN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.ED, NCC, LPCA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PRESUTTI",
    "OtherFirstName": "KIMBERLY",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.ED, NCC, LPCA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "636 BRIGHTON RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RALEIGH",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27610-1606",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "919-604-5521",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3801 LAKE BOONE TRL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RALEIGH",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27607-2934",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "919-865-8850",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/30/2013",
    "LastUpdateDate": "07/30/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": "A9068",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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