Kimberly Anne Wollgren O'Neill, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6701 Issued in NC

Practice address

1350 Whitaker Ridge Dr
Winston Salem, NC 27106-4966

Phone

(336) 718-8000

Fax

(336) 718-8011

NPI assigned

Sep 26, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Foster'S Care Facility, LLC

  • Developmentally Disabled Services Day Training Agency
  • High Point, NC
  • NPI 1679699565
  NPD (past)

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1083801724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2106 ARDSLEY ST.",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "607-857-3914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 WHITAKER RIDGE DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271064966",
            "telephone_number": "336-718-8000",
            "fax_number": "336-718-8011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "175 Kimel Park Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271036951",
            "country_code": "US",
            "telephone_number": "336-718-3550",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "213 Lindsay St",
            "address_purpose": "LOCATION",
            "city": "High Point",
            "state": "NC",
            "postal_code": "272624868",
            "country_code": "US",
            "telephone_number": "336-885-0602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOLLGREN O'NEILL",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-26",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "6701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "koneill887722@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1350 Whitaker Ridge Dr",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271064966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Warren Randal Taylor Wolfe III, MSW, LCSW
• Dylan Thomas Wolff, MD
• Merri Michael Wolff, NP
• Thomas Vincent Wolff, MD
• Neil Turner Wolfman, MD
• Melanie Christine Womble, NP
• Walker Schott Womble, PA-C
• Womens Health Alliance of the Piedmont PA
• Wonder Life Home Care Agency
• Andrew Peter Wong, MD

• Mental Health Counselor in Winston Salem, NC
• Providers in Winston Salem, 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 Oct 5, 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.