Active NPI
Kimberly L Konderla, MSW, LCSW
- Clinical Social Worker
- Oak Island, NC
National Provider Identifier
1093290678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C014277
- Practice address
- 118 SE 29TH St
Oak Island, NC 28465-6005 - Phone
- (713) 454-3870
- NPI assigned
- Sep 28, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C014277 | NC | Primary |
Addresses
Primary practice location
118 SE 29TH St
Oak Island, NC 28465-6005
Mailing address
118 SE 29TH St
Oak Island, NC 28465-6005
Phone (713) 454-3870
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C014277 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744070400000",
"number": "1093290678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 SE 29TH ST",
"city": "OAK ISLAND",
"state": "NC",
"postal_code": "284656005",
"telephone_number": "713-454-3870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 SE 29TH ST",
"city": "OAK ISLAND",
"state": "NC",
"postal_code": "284656005",
"telephone_number": "713-454-3870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONDERLA",
"first_name": "KIMBERLY",
"middle_name": "L",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-28",
"last_updated": "2025-04-08",
"certification_date": "2025-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C014277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Island, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.