Kimyatta Anderson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C005612 Issued in NC

Legal business name

KIMYATTA ANDERSON

Practice address

3707 N Main St
Farmville, NC 27828-1486

Phone

(252) 753-5100

Fax

(252) 753-5121

NPI assigned

Jun 20, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Kimyatta Anderson, LCSW,LCASNPI 1952521924

Title

Clinical Director

Phone

(252) 753-5100

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimyatta Shevone Anderson, LCSW, MSW

  • Clinical Social Worker
  • Farmville, NC
  • NPI 1952521924
  NPD (past) Authorized official
• Sonali Patel, LCAS

  • Addiction (Substance Use Disorder) Counselor
  • Farmville, NC
  • NPI 1316251424
  NPD (past)

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340236800000",
    "number": "1730442294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4204",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278362204",
            "telephone_number": "252-753-5100",
            "fax_number": "252-753-5121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3707 N MAIN ST",
            "city": "FARMVILLE",
            "state": "NC",
            "postal_code": "278281486",
            "telephone_number": "252-753-5100",
            "fax_number": "252-753-5121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMYATTA ANDERSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2012-06-21",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "KIMYATTA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "252-753-5100",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW,LCAS"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C005612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6106660",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Callie Johnson, AGPCNP-BC
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• Christina Kidd, NP-C
• Marion G Knight
• Kristin Lanier
• Sydney Denae Lassiter
• Tammy Squires Lee
• Martha M Libster, PHD, RN, CNS, AHN-BC

• Clinical Social Worker in Farmville, NC
• Providers in Farmville, 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 Jun 21, 2012; 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.