Kimberley Pavlak, LCMHC, LCAS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

13749 Issued in NC

Practice address

1513 Reynolds Mill Rd
Wake Forest, NC 27587-5613

Phone

(984) 230-9687

NPI assigned

Aug 24, 2018

Last updated

Oct 1, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696118400000",
    "number": "1073094389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8362 SIX FORKS RD STE 102",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276155086",
            "telephone_number": "984-230-9687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 REYNOLDS MILL RD",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875613",
            "telephone_number": "984-230-9687"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8362 Six Forks Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276155086",
            "country_code": "US",
            "telephone_number": "984-230-9687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAVLAK",
        "first_name": "KIMBERLEY",
        "credential": "LCMHC, LCAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-24",
        "last_updated": "2023-10-01",
        "certification_date": "2023-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "25270",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "13749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fevil Patel, PHARMD
• Jignya Patel, PT
• Sanjay D Patel, M.D.
• Patricia Matheis, MD, PC (Wake Forest Dermatology)
• Linda Diane Patrone, FNP
• Leslie Payne, MSW, LCSWA
• PC Consultants
• Megan Evans Pearce
• Tracie Lanae Pearsall
• Janine Pearson, M.S., CCC-SLP

• Professional Counselor in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.