Kimberly Moss Wilson, LCSW, CAADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005573 Issued in GA

Practice address

1116 E Ponce de Leon Ave
Decatur, GA 30030-2711

Phone

(404) 377-7669

Fax

(404) 377-8536

NPI assigned

Mar 3, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Kimberly Diane Moss Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Alliance Recovery Center, Inc.

  • Methadone Clinic
  • Decatur, GA
  • NPI 1003953548
  NPD (past)

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

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466726400000",
    "number": "1700246709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3921 KENSINGTON DR",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300662535",
            "telephone_number": "404-936-1431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 E PONCE DE LEON AVE",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302711",
            "telephone_number": "404-377-7669",
            "fax_number": "404-377-8536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIMBERLY",
        "middle_name": "MOSS",
        "credential": "LCSW, CAADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-03",
        "last_updated": "2016-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "C0159",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "MOSS",
            "middle_name": "DIANE",
            "credential": "LMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Denise Wilson
• Deshana N Wilson, CCC-SLP
• Glen Wilson, LCSW
• Jennifer Wilson, BCBA
• Julie F Wilson, LCSW
• Lucretia Wilson, LCSW
• Lynne H Wilson, PAA
• Lytani Wilson, MD, MPH
• Patricia Ann Wilson, MSN,RN,APRN,BC
• Shekemba Wilson, NUSRING AIDE

• Clinical Social Worker in Decatur, GA
• Providers in Decatur, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; 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.