Kelly Marie Wasson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C012739 Issued in NC

Practice address

2101 Peters Creek Pkwy Ste 16-19
Winston Salem, NC 27127-3726

Phone

(336) 955-1379

Fax

(704) 939-1173

NPI assigned

Sep 21, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1063921161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 PETERS CREEK PKWY STE 16-19",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271273726",
            "telephone_number": "336-955-1379",
            "fax_number": "704-939-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 PETERS CREEK PKWY STE 16-19",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271273726",
            "telephone_number": "336-955-1379",
            "fax_number": "704-939-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSON",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-21",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C012739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlie Washington
• Morgan Washington
• Samantha Washington, MS, CFY-SLP
• Victoria Sade' Washington
• Katherine Maryann Wasowski, DNP, FNP-BC
• Grace Evelyn Wasulko
• Courtney White Waszczeniuk, FNP-C
• Ronald Patton Waterer, M.D.
• Brian Robert Waterman, MD
• Gregory Stiegler Waters, MD

• Clinical Social Worker in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.