KIMBERLY LYNN CHILDRESS MA, LPC, LCMHCS
NPI 1043675275
Counselor - Mental Health in Charlotte, NC

Q: What is Kimberly Childress's NPI number?

The NPI number for Kimberly Childress is 1043675275. It was assigned to this individual provider in the NPPES registry on December 14, 2015.

Q: What is Kimberly Childress's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Active since December 14, 2015PECOS Enrolled

10430 HARRIS OAK BLVD STE L, CHARLOTTE, NC 28269(704) 360-3637(704) 200-9829 Get Directions Write a Review

NPPES record last updated: December 14, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 14, 2023, Jun 11, 2019, Jan 7, 2019 and 1 more (4 updates tracked since 2015).

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About Kimberly Lynn Childress Ma, Lpc, Lcmhcs NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIMBERLY LYNN CHILDRESS MA, LPC, LCMHCS (NPI 1043675275) is an individual mental health provider in Charlotte, North Carolina, licensed in North Carolina (S15220) and active in the NPI registry since December 2015. She is enrolled in Medicare PECOS and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1043675275

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameKIMBERLY LYNN CHILDRESSCredential: MA, LPC, LCMHCS

Location Address10430 HARRIS OAK BLVD STE LCharlotte, NC 28269-7513

Mailing Address10430 Harris Oak Blvd Ste LCharlotte, NC 28269-7513 · (704) 360-3637 · Fax (704) 200-9829

Phone(704) 360-3637

Fax(704) 200-9829

Sole ProprietorNo

Enumeration DateDecember 14, 2015

Last NPPES UpdateDecember 14, 20234 updates tracked since enumeration

NPPES CertifiedDecember 14, 2023

✔ NPI 1043675275 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in NC · S15220

Also ListedCounselorTaxonomy 101Y00000X · License 6208 (SC)

10430 HARRIS OAK BLVD STE L, Charlotte, NC 28269

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Secondary Practice Locations 3

Location 1514 W Palmetto St Ste 2BFlorence, SC 29501-4428 · Phone (843) 250-4589 · Fax (843) 410-5698

Location 21803 Cherokee RdFlorence, SC 29501-4184 · Phone (843) 409-3046

Location 32000 Regency Pkwy Ste 255Cary, NC 27518-8511 · Phone (704) 360-3637 · Fax (704) 200-9829

Other Identifiers 1

MedicaidEJ7GST1IO450JIHSC

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kimberly Lynn Childress Ma, Lpc, Lcmhcs is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. CELENA NICOLE SHIVERS PMHNP

Nurse Practitioner (Psychiatric/Mental Health)