MEDICARE: MISS KIMBERLY DREW COLGAN NCC, LCMHC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A16850	NC

General Provider Information

NPI Number	:	1083384085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIMBERLY DREW COLGAN NCC, LCMHC-A

Provider Business Mailing Address
First Line	:	1903 N HARRISON AVE STE 100
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-3003
Country	:	US
Telephone Number	:	919-463-7890
Fax Number	:	919-463-7665

Provider Business Practice Location Address
First Line	:	1903 N HARRISON AVE STE 100
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-3003
Country	:	US
Telephone Number	:	919-463-7890
Fax Number	:	919-463-7665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/20/2021

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