Provider Demographics
NPI:1487480455
Name:BINAN, KIMBERLY ANN (LCSWA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:BINAN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 DAMSEL CT
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28356-8053
Mailing Address - Country:US
Mailing Address - Phone:413-977-3271
Mailing Address - Fax:
Practice Address - Street 1:1540 PURDUE DR STE 100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5509
Practice Address - Country:US
Practice Address - Phone:910-900-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0209651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical