Provider Demographics
NPI:1427751882
Name:HULETT, KIMBERLY EVONNE (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:EVONNE
Last Name:HULETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:EVONNE
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2004 CAROLYN TER
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2102
Mailing Address - Country:US
Mailing Address - Phone:229-834-1315
Mailing Address - Fax:
Practice Address - Street 1:1736 W GORDON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-3017
Practice Address - Country:US
Practice Address - Phone:229-262-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA84701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical