Kimberly Antoine Scott, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C004666 Issued in NC

Practice address

112 S. Brooks St.
Wake Forest, NC 27587-5008

Phone

(919) 324-7361

Fax

(919) 640-1901

NPI assigned

Nov 6, 2006

Last updated

Jul 27, 2015By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Agape of NC, Inc. (Asso. for Guidance, Aid, Placement & Empathy of NC.

  dba AGAPE of NC. Inc.

  • Foster Care Agency
  • Wake Forest, NC
  • NPI 1962807842
  Authorized official Same address or phone
• Kimberly Scott, PLLC

  • Clinical Social Worker
  • Wake Forest, NC
  • NPI 1790166593
  NPD (past) Authorized official

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437955200000",
    "number": "1093884108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 985",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275880985",
            "telephone_number": "919-673-7816",
            "fax_number": "919-640-1901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 S. BROOKS ST.",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875008",
            "telephone_number": "919-324-7361",
            "fax_number": "919-640-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "KIMBERLY",
        "middle_name": "ANTOINE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2015-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002801",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary Schwager, LPC
• Rachel Renee Costin Schwenn, LCMHCA
• Adrienne Scigliano, M.A., CCC-SLP
• Billy Scott II, MS, MHS, PA-C
• Kendra Tawanna Scott, LPCA
• Second Time Around Homecare
• Blair Brenna Seelinger, M ED., LPCA, LMFTA
• Katherine Eileen Sega
• Eric Seidel, RPH
• Kelly Brophy Seidel, RPH

• Clinical Social Worker in Wake Forest, NC
• Providers in Wake Forest, 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 Jul 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.