Provider Demographics
NPI:1285496521
Name:CROMARTIE, KIMBERLY RENAE (LMSW)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:RENAE
Last Name:CROMARTIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:RENAE
Other - Last Name:CROMARTIE-WINDHOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:604 RENAISSANCE WAY
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-8013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3300 NORTHEAST EXPY NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3932
Practice Address - Country:US
Practice Address - Phone:404-900-5915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health