Provider Demographics
NPI:1174877245
Name:GIDDO, KIMBERLY MCINTYRE (LPC, NCC, MED, EDS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MCINTYRE
Last Name:GIDDO
Suffix:
Gender:F
Credentials:LPC, NCC, MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7045
Mailing Address - Country:US
Mailing Address - Phone:910-796-6868
Mailing Address - Fax:910-313-6598
Practice Address - Street 1:5013 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7045
Practice Address - Country:US
Practice Address - Phone:910-796-6868
Practice Address - Fax:910-313-6598
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9662101YM0800X
NC9662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health