Healthcare Provider Details

I. General information

NPI: 1538091087
Provider Name (Legal Business Name): KIMBERLY DENSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 JEFFERY THOMAS DR
BONAIRE GA
31005-6300
US

IV. Provider business mailing address

616 JEFFERY THOMAS DR
BONAIRE GA
31005-6300
US

V. Phone/Fax

Practice location:
  • Phone: 478-233-0662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010029
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: