Provider Demographics
NPI:1437439338
Name:KEMP, CAROL ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:KEMP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:DEROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2124 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3317
Mailing Address - Country:US
Mailing Address - Phone:254-235-2430
Mailing Address - Fax:254-235-2434
Practice Address - Street 1:2124 N 25TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3317
Practice Address - Country:US
Practice Address - Phone:254-235-2430
Practice Address - Fax:254-235-2434
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28062104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker