Provider Demographics
NPI:1710576830
Name:SCREWS, KIMIRIA LEESHAE (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:KIMIRIA
Middle Name:LEESHAE
Last Name:SCREWS
Suffix:
Gender:F
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:KIMIRIA
Other - Middle Name:LEESHAE
Other - Last Name:SEWEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 DEVONHURST DR APT D2
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2108
Mailing Address - Country:US
Mailing Address - Phone:334-355-0714
Mailing Address - Fax:
Practice Address - Street 1:4449 EASTON WAY STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-7005
Practice Address - Country:US
Practice Address - Phone:614-934-1857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2207875104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2910854Medicaid