Provider Demographics
NPI:1245713585
Name:CLARKE, KIMBERLY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:CLARKE
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 1:2415 MORGANTON BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-9691
Mailing Address - Country:US
Mailing Address - Phone:828-394-4444
Mailing Address - Fax:
Practice Address - Street 1:2415 MORGANTON BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-9691
Practice Address - Country:US
Practice Address - Phone:828-394-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0153401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical