Provider Demographics
NPI:1154908465
Name:GREER, KIMATHA L (LLMSW)
Entity type:Individual
Prefix:
First Name:KIMATHA
Middle Name:L
Last Name:GREER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41173 WYNDCHASE BLVD APT SUITE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1997
Mailing Address - Country:US
Mailing Address - Phone:248-949-7429
Mailing Address - Fax:
Practice Address - Street 1:5840 N CANTON CENTER RD STE 224
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2684
Practice Address - Country:US
Practice Address - Phone:734-787-5872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011090781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical