Provider Demographics
NPI:1518963149
Name:HARRIS, KIMBERLY DENISE (LCSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DENISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8011 BROOKS CHAPEL RD STE 3761
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3964
Mailing Address - Country:US
Mailing Address - Phone:417-312-9025
Mailing Address - Fax:
Practice Address - Street 1:8011 BROOKS CHAPEL RD STE 3761
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3964
Practice Address - Country:US
Practice Address - Phone:417-312-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8769C1041C0700X
TNLSW00000042571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical