Healthcare Provider Details

I. General information

NPI: 1558432757
Provider Name (Legal Business Name): KIM HULSEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LESTER RD
STATESBORO GA
30458-2119
US

IV. Provider business mailing address

19 LESTER RD
STATESBORO GA
30458-2119
US

V. Phone/Fax

Practice location:
  • Phone: 912-662-6501
  • Fax: 912-681-1012
Mailing address:
  • Phone: 912-662-6501
  • Fax: 912-681-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW000778
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: