Kimberly Renee Ennis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C003979 Issued in NC

Practice address

75 Hampstead VLG
Hampstead, NC 28443-8250

Phone

(910) 270-3811

Fax

(910) 270-3897

NPI assigned

Mar 19, 2007

Last updated

Jul 9, 2007By 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 3

Other names 1

• Mrs. Kimberly Renee Sulecki Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Growing Pains, P.a.

  • Clinical Social Worker
  • Hampstead, NC
  • NPI 1326162629
  NPD (past)

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1740304476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 HAMPSTEAD VLG",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284438250",
            "telephone_number": "910-270-3811",
            "fax_number": "910-270-3897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 HAMPSTEAD VLG",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284438250",
            "telephone_number": "910-270-3811",
            "fax_number": "910-270-3897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "KIMBERLY",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-19",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C003979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002279",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "186473",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "130XR",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "SULECKI",
            "middle_name": "RENEE",
            "prefix": "MRS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erica Eckel
• Laura Eichman DC, PLLC, DC
• Mia Elizabeth Elder
• Emerald Isle Behavioral Healthcare, Inc.
• Emergeortho, PA
• Dillon Estes, PT
• Kayeloni Everhart, MSW, LCSW
• Wendy Falkowski, MS CCC-SLP
• Lori Anne Farabaugh, OD
• Joseph S Farmer IV, PA-C

• Clinical Social Worker in Hampstead, NC
• Providers in Hampstead, 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 9, 2007; 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.