Kimberly Lynn Childress, MA, LPC, LCMHCS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

S15220 Issued in NC

Practice address

10430 Harris Oak Blvd Ste L
Charlotte, NC 28269-7513

Phone

(704) 360-3637

Fax

(704) 200-9829

NPI assigned

Dec 14, 2015

Last updated

Dec 14, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carolina Hope and Healing, LLC

  • Mental Health Counselor
  • Florence, SC
  • NPI 1386115079
  NPD
• Asheli Thompson

  dba Integrative Wellness Solutions

  • Community/Behavioral Health Agency
  • Mooresville, NC
  • NPI 1073955621

  Counselor

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1043675275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10430 HARRIS OAK BLVD STE L",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282697513",
            "telephone_number": "704-360-3637",
            "fax_number": "704-200-9829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10430 HARRIS OAK BLVD STE L",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282697513",
            "telephone_number": "704-360-3637",
            "fax_number": "704-200-9829"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Regency Pkwy Ste 255",
            "address_purpose": "LOCATION",
            "city": "Cary",
            "state": "NC",
            "postal_code": "275188511",
            "country_code": "US",
            "telephone_number": "704-360-3637",
            "fax_number": "704-200-9829",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1803 Cherokee Rd",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "SC",
            "postal_code": "295014184",
            "country_code": "US",
            "telephone_number": "843-409-3046",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "514 W Palmetto St Ste 2B",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "SC",
            "postal_code": "295014428",
            "country_code": "US",
            "telephone_number": "843-250-4589",
            "fax_number": "843-410-5698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHILDRESS",
        "first_name": "KIMBERLY",
        "middle_name": "LYNN",
        "credential": "MA, LPC, LCMHCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-14",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "SC",
            "license": "6208",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "S15220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EJ7GST1IO450JIH",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Children's Therapy & Tutoring Associates, PLLC
• Children's Urology of the Carolinas
• Debra A Childress, LCSW
• Imani Childress
• Jerry Wayne Childress, DDS
• Lauren Michelle Childs, PA
• Sharlene V Childs, OTRL
• Thomas Ray Childs, MD
• Childworks Therapy, LLC
• Ashley Elisabeth Chillingsworth, PA-C

• Mental Health Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.