Healthcare Provider Details

I. General information

NPI: 1851040042
Provider Name (Legal Business Name): KYMBERLY ANGELINA MCPHERSON SAMPSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3991 HIGHWAY 78 W STE 203
SNELLVILLE GA
30039-3929
US

IV. Provider business mailing address

3991 HIGHWAY 78 W STE 203
SNELLVILLE GA
30039-3929
US

V. Phone/Fax

Practice location:
  • Phone: 770-978-9393
  • Fax: 770-978-9324
Mailing address:
  • Phone: 770-978-9393
  • Fax: 770-978-9324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007999
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: