Healthcare Provider Details

I. General information

NPI: 1356917397
Provider Name (Legal Business Name): KIMBERLEY M. WICKER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 KINARD ST
NEWBERRY SC
29108-2909
US

IV. Provider business mailing address

47A REDBIRD LN
LITTLE MOUNTAIN SC
29075-9326
US

V. Phone/Fax

Practice location:
  • Phone: 803-405-0220
  • Fax:
Mailing address:
  • Phone: 803-768-7082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17601
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: