1407635782 NPI number — CYNTHIA DARLENE KILBY-QUEEN LCAS, LCMHCA, CADC

Table of content: KAIRA SIMS BCBA (NPI 1225530116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407635782 NPI number — CYNTHIA DARLENE KILBY-QUEEN LCAS, LCMHCA, CADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILBY-QUEEN
Provider First Name:
CYNTHIA
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCAS, LCMHCA, CADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407635782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
633 CARTPATH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH WILKESBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28659-8250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-978-2717
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
924 MAIN ST STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH WILKESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28659-4266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-818-9238
Provider Business Practice Location Address Fax Number:
336-810-7780
Provider Enumeration Date:
09/26/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  A19638 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: LCAS-26257 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)