Kimberly Lynn Clicquennoi, LCMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

7108 Issued in NC

Practice address

355 S Madison Blvd
Suite C2
Roxboro, NC 27573-5485

Phone

(336) 597-2065

Fax

(336) 597-2116

NPI assigned

Jul 11, 2008

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

Other names 1

• Kim Synan Former name

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": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767052800000",
    "number": "1457515157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3210 FAIRHILL DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123215",
            "telephone_number": "919-256-0824",
            "fax_number": "919-256-0833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 S MADISON BLVD",
            "address_2": "SUITE C2",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275735485",
            "telephone_number": "336-597-2065",
            "fax_number": "336-597-2116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLICQUENNOI",
        "first_name": "KIMBERLY",
        "middle_name": "LYNN",
        "credential": "LCMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-11",
        "last_updated": "2025-12-30",
        "certification_date": "2025-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "7108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "SYNAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chrysalis Foundation for Mental Health, Inc
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• Amanda Reaves Clayton, RPH
• Bryan Kevin Clayton, CPSS,MH,SA
• Thomas Preston Brinn Clayton, MA, LMFT
• Adam Joseph Clodfelter
• Kristen Frey Cole, RN, CPNP
• Winstona Daisy Cole
• Coles Pharmacy Inc
• Community Counseling Services, PC.

• All providers in Roxboro, NC
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2025; 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.