Healthcare Provider Details

I. General information

NPI: 1750678470
Provider Name (Legal Business Name): KIMBERLY MAKUCH LEPPERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 S. MAIN ST SUITE 200
DAVIDSON NC
28036
US

IV. Provider business mailing address

432 S. MAIN ST SUITE 200
DAVIDSON NC
28036
US

V. Phone/Fax

Practice location:
  • Phone: 980-225-2321
  • Fax:
Mailing address:
  • Phone: 980-225-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC008085
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierC008085
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerLICENCED CLINICAL SOCIAL WORKER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: