Provider Demographics
NPI:1316437056
Name:AZEVEDO, KIMBERLY M (LMFTA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:AZEVEDO
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 N HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3093
Mailing Address - Country:US
Mailing Address - Phone:919-624-9568
Mailing Address - Fax:919-404-7124
Practice Address - Street 1:1903 N HARRISON AVE STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3093
Practice Address - Country:US
Practice Address - Phone:919-624-9568
Practice Address - Fax:919-404-7124
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12088A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist