Provider Demographics
NPI:1235585720
Name:PALMER, KIMBERLY (LCSW-C, LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:LCSW-C, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4356 OWENDON DR
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4317
Mailing Address - Country:US
Mailing Address - Phone:910-714-9119
Mailing Address - Fax:
Practice Address - Street 1:610 OCEAN HWY W
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4048
Practice Address - Country:US
Practice Address - Phone:910-253-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD151541041C0700X
NCC0129791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical