Provider Demographics
NPI:1487978078
Name:REESE, KIMBERLY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10617 PRAIRIE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4811
Mailing Address - Country:US
Mailing Address - Phone:704-426-3419
Mailing Address - Fax:704-980-7662
Practice Address - Street 1:7810 PINEVILLE MATTHEWS RD STE 5
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5300
Practice Address - Country:US
Practice Address - Phone:704-426-3419
Practice Address - Fax:704-980-7662
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0074721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical