Provider Demographics
NPI:1558432757
Name:HULSEY, KIM (LCSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:HULSEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LESTER RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-2119
Mailing Address - Country:US
Mailing Address - Phone:912-662-6501
Mailing Address - Fax:912-681-1012
Practice Address - Street 1:19 LESTER RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2119
Practice Address - Country:US
Practice Address - Phone:912-662-6501
Practice Address - Fax:912-681-1012
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0007781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00957877AMedicaid
GAP61550Medicare UPIN
GA80BBFMKMedicare ID - Type Unspecified