MEDICARE: MRS. KIMBERLY JOHNSON DUARTE M.ED., LPC, NCC

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	101Y00000X	Counselor	2029	NC

General Provider Information

NPI Number	:	1144455098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY JOHNSON DUARTE M.ED., LPC, NCC

Provider Business Mailing Address
First Line	:	4600 W LAKE RD
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27539-7657
Country	:	US
Telephone Number	:	919-662-2922
Fax Number	:	919-662-2938

Provider Business Practice Location Address
First Line	:	4600 W LAKE RD
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27539-7657
Country	:	US
Telephone Number	:	919-662-2922
Fax Number	:	919-662-2938

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

Provider Enumeration Date	:	05/21/2009
Last Update Date	:	05/21/2009

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