Provider Demographics
NPI:1689275224
Name:LINCOLN, KEARA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KEARA
Middle Name:ANN
Last Name:LINCOLN
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 1:1054 ANNA KNAPP BLVD APT 13D
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3168
Mailing Address - Country:US
Mailing Address - Phone:843-566-3361
Mailing Address - Fax:
Practice Address - Street 1:1054 ANNA KNAPP BLVD APT 13D
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3168
Practice Address - Country:US
Practice Address - Phone:843-566-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC157991041C0700X
SC13593104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740897321OtherGROUP NPI