Healthcare Provider Details

I. General information

NPI: 1326963364
Provider Name (Legal Business Name): KIMBERLY WOODWARD MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 SAM NEWELL RD STE 100
MATTHEWS NC
28105-7593
US

IV. Provider business mailing address

855 SAM NEWELL RD STE 100
MATTHEWS NC
28105-7593
US

V. Phone/Fax

Practice location:
  • Phone: 980-446-1960
  • Fax:
Mailing address:
  • Phone: 980-446-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024317
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: