MEDICARE: KIMBERLY ANNETTE TALBOT LCSW-A

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	P0011326	NC

General Provider Information

NPI Number	:	1255866257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNETTE TALBOT LCSW-A

Provider Business Mailing Address
First Line	:	2407 S MEMORIAL DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5018
Country	:	US
Telephone Number	:	252-723-6616
Fax Number	:

Provider Business Practice Location Address
First Line	:	2407 S MEMORIAL DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5018
Country	:	US
Telephone Number	:	252-723-6616
Fax Number	:

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

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/27/2017

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Directions to “ KIMBERLY ANNETTE TALBOT LCSW-A” Practice Location

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