Provider Demographics
NPI:1710576830
Name:SCREWS, KIMIRIA LEESHAE (MSW, LISW)
Entity type:Individual
Prefix:
First Name:KIMIRIA
Middle Name:LEESHAE
Last Name:SCREWS
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:KIMIRIA
Other - Middle Name:LEESHAE
Other - Last Name:SEWEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2249 CYBELLE CT
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7440
Mailing Address - Country:US
Mailing Address - Phone:937-901-0002
Mailing Address - Fax:
Practice Address - Street 1:7250 POE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2687
Practice Address - Country:US
Practice Address - Phone:937-912-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI25072911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2910854Medicaid