Provider Demographics
NPI:1073772208
Name:SARGENT, KIMBERLY W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:W
Last Name:SARGENT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:W
Other - Last Name:COLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TN
Mailing Address - Zip Code:37322-0521
Mailing Address - Country:US
Mailing Address - Phone:434-242-3067
Mailing Address - Fax:
Practice Address - Street 1:1000 E 3RD ST STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2153
Practice Address - Country:US
Practice Address - Phone:423-648-9939
Practice Address - Fax:423-648-9935
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000068861041C0700X
VA09040068141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical