MEDICARE: SUSAN POTTS KIMBERLY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C003850	NC

General Provider Information

NPI Number	:	1164709135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN POTTS KIMBERLY LCSW

Provider Business Mailing Address
First Line	:	302 SUNSET CREEK CIR
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-4628
Country	:	US
Telephone Number	:	703-254-4024
Fax Number	:	888-972-1187

Provider Business Practice Location Address
First Line	:	6101 QUADRANGLE DR
Second Line	:	SUITE #100
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-8655
Country	:	US
Telephone Number	:	919-445-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2011
Last Update Date	:	01/07/2020

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