Provider Demographics
NPI:1780819854
Name:MCALISTER, KIMBERLY (LISW-CP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MCALISTER
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 MILLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1827
Mailing Address - Country:US
Mailing Address - Phone:803-917-3946
Mailing Address - Fax:803-254-4406
Practice Address - Street 1:3204 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1827
Practice Address - Country:US
Practice Address - Phone:803-917-3946
Practice Address - Fax:803-254-4406
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical