Provider Demographics
NPI:1588156418
Name:BOONE, KIMELA (LCSW)
Entity type:Individual
Prefix:
First Name:KIMELA
Middle Name:
Last Name:BOONE
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 1:403 PLANTAIN TER
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4026
Mailing Address - Country:US
Mailing Address - Phone:404-304-4784
Mailing Address - Fax:
Practice Address - Street 1:1 MARSH HAVEN LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:FL
Practice Address - Zip Code:34957
Practice Address - Country:US
Practice Address - Phone:404-304-4784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC132771041C0700X
FLSW113811041C0700X
GACSW0052971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical