MEDICARE: KARA ELIZABETH BUMGARDNER LCMHC

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	19023	NC
2	1041C0700X	Clinical Social Worker	A19023	NC

General Provider Information

NPI Number	:	1639850449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA ELIZABETH BUMGARDNER LCMHC

Provider Business Mailing Address
First Line	:	200 E 2ND AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4358
Country	:	US
Telephone Number	:	704-874-1936
Fax Number	:

Provider Business Practice Location Address
First Line	:	1774 SAINT JAMES CHURCH RD
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-7515
Country	:	US
Telephone Number	:	704-736-1958
Fax Number	:	704-736-1947

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

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	03/05/2026

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