Provider Demographics
NPI:1336494210
Name:KIMBALL, SUSAN P (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:P
Last Name:KIMBALL
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 1:178 BUCK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28785-7405
Mailing Address - Country:US
Mailing Address - Phone:828-226-7366
Mailing Address - Fax:888-965-3992
Practice Address - Street 1:178 BUCK RIDGE RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28785-7405
Practice Address - Country:US
Practice Address - Phone:828-246-6100
Practice Address - Fax:828-246-6100
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0083841041C0700X
FLSW59521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD426Medicare PIN