Provider Demographics
NPI:1699258996
Name:SEYMOUR, KIAM MALIJA (LCSWA)
Entity type:Individual
Prefix:
First Name:KIAM
Middle Name:MALIJA
Last Name:SEYMOUR
Suffix:
Gender:
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 QUEENS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3257
Mailing Address - Country:US
Mailing Address - Phone:704-980-3082
Mailing Address - Fax:704-980-3082
Practice Address - Street 1:200 QUEENS RD STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3257
Practice Address - Country:US
Practice Address - Phone:704-980-3082
Practice Address - Fax:704-980-3082
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0217481041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical