Individual
SHANEQUA KIMBLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
301 LUCY LN, CARROLLTON, GA 30117-8506
(678) 557-1968
Mailing address
301 LUCY LN, CARROLLTON, GA 30117-8506
(678) 557-1968
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
9291
CT
1041C0700X
Clinical Social Worker
Primary
CSW03549
RI
Other
Enumeration date
01/19/2024
Last updated
01/19/2024
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