Provider Demographics
NPI:1629318969
Name:HART, KIA MICHELLE (LCSW-A)
Entity Type:Individual
Prefix:MS
First Name:KIA
Middle Name:MICHELLE
Last Name:HART
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:MS
Other - First Name:KITTY
Other - Middle Name:MICHELLE
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-A
Mailing Address - Street 1:106 OSTERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7525
Mailing Address - Country:US
Mailing Address - Phone:919-282-8656
Mailing Address - Fax:
Practice Address - Street 1:106 OSTERVILLE DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7525
Practice Address - Country:US
Practice Address - Phone:919-282-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA006782101Y00000X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker