Kimberly R Wilson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

KY 3505 Issued in KY

Practice address

1815 Destiny LN Ste C
Bowling Green, KY 42104-1074

Phone

(270) 904-1072

Fax

(270) 904-1073

NPI assigned

Mar 11, 2011

Last updated

Jul 9, 2026By 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 KY

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

Specialty

Clinical Social Worker

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Wilson Counseling LLC

  • Clinical Social Worker
  • Bowling Green, KY
  • NPI 1427480060
  Medicare reassignment NPD
• Wilson Counseling, LLC

  dba Wilson Place

  • Community/Behavioral Health Agency
  • Bowling Green, KY
  • NPI 1649640921
  NPD

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

{
    "created_epoch": "1299801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783555200000",
    "number": "1255639431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 DESTINY LN STE C",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421041074",
            "telephone_number": "270-904-1072",
            "fax_number": "270-904-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 DESTINY LN STE C",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421041074",
            "telephone_number": "270-904-1072",
            "fax_number": "270-904-1073"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "252 N Main St",
            "address_purpose": "LOCATION",
            "city": "Russellville",
            "state": "KY",
            "postal_code": "422761825",
            "country_code": "US",
            "telephone_number": "270-904-1072",
            "fax_number": "270-904-1073",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1312 Westen St",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "KY",
            "postal_code": "421043352",
            "country_code": "US",
            "telephone_number": "270-904-1072",
            "fax_number": "270-904-1073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIMBERLY",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-11",
        "last_updated": "2026-07-09",
        "certification_date": "2026-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "KY 3505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100269010",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dava R Wilson, CSW
• Demara Wilson
• Dustin Ray Wilson, MS ATC CSCS
• Gene O'Neil Wilson Jr., M.D.
• Jessica Evelynne Wilson, M.S., CCC-SLP
• Mercedez Wilson
• Rita Wilson, APRN
• Saleana Wilson
• Sarah Wilson, LPCA
• Valerie Wilson, APRN

• Clinical Social Worker in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.