Provider Demographics
NPI:1396373601
Name:YOUNG, KIMBERLY ANIEKA (LCSW-A)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANIEKA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 WESTWOOD AVE W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-2756
Mailing Address - Country:US
Mailing Address - Phone:252-289-5716
Mailing Address - Fax:
Practice Address - Street 1:109 S ELM ST
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-9181
Practice Address - Country:US
Practice Address - Phone:336-500-2403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0144851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP014485Medicaid