Kimberly Vaughan Willett, LCSW, MSW, BA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904011868 Issued in VA

Practice address

4224 Holland Rd Ste 106
Virginia Beach, VA 23452-1900

Phone

(757) 320-5819

NPI assigned

Apr 1, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

Virginia Commonwealth University, School of Medicine, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Arts

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 and National Provider Directory roles.

• Virginia Beach Clinical Counseling LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Virginia Beach, VA
  • NPI 1144847948
  Medicare reassignment NPD Authorized official
• Beach Counseling, LLC

  • Psychiatric/Mental Health Clinical Nurse Specialist
  • Virginia Beach, VA
  • NPI 1689162547
  NPD (past)
• Reboot Functional Health Care Corporation

  • Family Medicine Physician
  • Virginia Beach, VA
  • NPI 1427709526
  NPD (past)

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

{
    "created_epoch": "1554076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697760000000",
    "number": "1366904385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 LA TIERRA CT",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234566432",
            "telephone_number": "757-427-5007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4224 HOLLAND RD STE 106",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234521900",
            "telephone_number": "757-320-5819"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Columbus Ctr Ste 600",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234626760",
            "country_code": "US",
            "telephone_number": "757-828-2159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLETT",
        "first_name": "KIMBERLY",
        "middle_name": "VAUGHAN",
        "credential": "LCSW, MSW, BA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-01",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904011868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Braxton Reid Wilkinson
• Brooke Rae Totzeck Wilkinson
• Nicole Wilkinson
• Caitlin Will, CF-SLP
• Rachel Lynne Willcoxon, OD
• Joanna Felix Willette
• William Crist Wellness LLC
• William W Townsend OD PC
• Kaysiera Felicia Williams Pollard
• Krystal Williams Sweeney

• Clinical Social Worker in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; 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.