Healthcare Provider Details

I. General information

NPI: 1528862737
Provider Name (Legal Business Name): KIMBERLY MARIE WATT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2479 IVY CREEK FRD
YORK SC
29745-8138
US

IV. Provider business mailing address

2479 IVY CREEK FRD
YORK SC
29745-8138
US

V. Phone/Fax

Practice location:
  • Phone: 734-341-5007
  • Fax:
Mailing address:
  • Phone: 734-341-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18585
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: