Provider Demographics
NPI:1063033348
Name:LONG, KIMBERLY (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 GROVE LAKE WAY UNIT 106
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5199
Mailing Address - Country:US
Mailing Address - Phone:865-924-7249
Mailing Address - Fax:865-675-2003
Practice Address - Street 1:10415 HICKORY PATH WAY STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-0701
Practice Address - Country:US
Practice Address - Phone:865-671-1274
Practice Address - Fax:865-675-2003
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN88871041C0700X
TN76011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical