Provider Demographics
NPI:1316646128
Name:WATERS, KIMBELL BINGHAM (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBELL
Middle Name:BINGHAM
Last Name:WATERS
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 1:1036 MANSHIP ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2132
Mailing Address - Country:US
Mailing Address - Phone:601-533-7017
Mailing Address - Fax:
Practice Address - Street 1:1036 MANSHIP ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2132
Practice Address - Country:US
Practice Address - Phone:601-533-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC87251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical