Provider Demographics
NPI:1699165928
Name:MOTON, KIMBERLY (DSW,MSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:MOTON
Suffix:
Gender:F
Credentials:DSW,MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 PINE SHADOWS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70615-2992
Mailing Address - Country:US
Mailing Address - Phone:337-391-1860
Mailing Address - Fax:
Practice Address - Street 1:4235 PINE SHADOWS LN
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-2992
Practice Address - Country:US
Practice Address - Phone:337-391-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW151111041C0700X
LA15651171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator