Provider Demographics
NPI:1366148389
Name:GAULDIN, KIMBERLY MARTIN
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARTIN
Last Name:GAULDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 OLD US HIGHWAY 29
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27311-8804
Mailing Address - Country:US
Mailing Address - Phone:336-552-5102
Mailing Address - Fax:
Practice Address - Street 1:1555 MEADOWVIEW DR STE 5
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-7352
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)