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Organization
KIMYATTA ANDERSON
Active
Organization
KIMYATTA ANDERSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMYATTA ANDERSON LCSW,LCAS (CLINICAL DIRECTOR)
(252) 753-5100
Entity
Organization
Contact information
Practice address
3707 N MAIN ST, FARMVILLE, NC 27828-1486
(252) 753-5100
(252) 753-5121
Mailing address
PO BOX 4204, GREENVILLE, NC 27836-2204
(252) 753-5100
(252) 753-5121
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C005612
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6106660
—
NC
Enumeration date
06/20/2012
Last updated
06/21/2012
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