Provider Demographics
NPI:1710969605
Name:MITCHELL, KIMLIE MORRISON (MSW,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMLIE
Middle Name:MORRISON
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 AMITY HILL CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2869
Mailing Address - Country:US
Mailing Address - Phone:919-846-1647
Mailing Address - Fax:
Practice Address - Street 1:5561 MCNEELY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7625
Practice Address - Country:US
Practice Address - Phone:919-782-0272
Practice Address - Fax:919-782-0322
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0026251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC335085Medicare UPIN
NC2878003Medicare ID - Type Unspecified
NC1345PMedicare UPIN