Provider Demographics
NPI:1750685756
Name:EPPERSON, KIMBERLEY CAROLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:CAROLYN
Last Name:EPPERSON
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 1:3340 SEVERN AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-7407
Mailing Address - Country:US
Mailing Address - Phone:504-889-1448
Mailing Address - Fax:504-889-1452
Practice Address - Street 1:3340 SEVERN AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-7407
Practice Address - Country:US
Practice Address - Phone:504-889-1448
Practice Address - Fax:504-889-1452
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA44071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3C234D670Medicare PIN