Provider Demographics
NPI:1720606783
Name:SIMPSON, KIM GOFORTH (LCSW)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:GOFORTH
Last Name:SIMPSON
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 1:1050 CAMBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-0504
Mailing Address - Country:US
Mailing Address - Phone:980-355-1429
Mailing Address - Fax:
Practice Address - Street 1:818 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081-4918
Practice Address - Country:US
Practice Address - Phone:980-355-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC09169481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical