Provider Demographics
NPI:1609208875
Name:SMITLEY, KIMBERLY ANN (MED, NCC, LPCA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:SMITLEY
Suffix:
Gender:F
Credentials:MED, NCC, LPCA
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:PRESUTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, NCC, LPCA
Mailing Address - Street 1:636 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1606
Mailing Address - Country:US
Mailing Address - Phone:919-604-5521
Mailing Address - Fax:
Practice Address - Street 1:3801 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-2934
Practice Address - Country:US
Practice Address - Phone:919-865-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health