Kim L Boubon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C004740 Issued in NC

Practice address

13850 Ballantyne Corporate Place
Suite #500
Charlotte, NC 28277

Phone

(704) 341-1226

NPI assigned

May 1, 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1609097203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9319 BELLEGARDE DRIVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28277",
            "telephone_number": "704-341-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13850 BALLANTYNE CORPORATE PLACE",
            "address_2": "SUITE #500",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28277",
            "telephone_number": "704-341-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUBON",
        "first_name": "KIM",
        "middle_name": "L",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002946",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy Lee Botic, LAT, ATC
• Julia Bott, CRNA
• Natalie Lynn Bott
• Emmanuel John Botzolakis, M.D., PH.D.
• Bou Mjahed,DDS,PLLC
• Jonathan Daniel Bouchez, M.D.
• Grace Catherine Bouchoucha, LCSWA
• Erin Nicole Boudoin
• Victoria Bouhairie, M.D.
• Tiffany E Bould, FNP-C,APRN

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.