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NPI Code Detail

MEDICARE: MRS. KIM NICOLE BARSELLA MSW, LCSW-C, LICSW

MEDICARE: MRS. KIM NICOLE BARSELLA MSW, LCSW-C, LICSW
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
11041C0700XClinical Social WorkerLC303019DC
21041C0700XClinical Social Worker10793MD

General Provider Information

NPI Number : 1346473105
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIM NICOLE BARSELLA MSW, LCSW-C, LICSW
Provider Business Mailing Address
First Line : 2500 DALLAS HWY SW # 202-1249
Second Line :
City : MARIETTA
State : GA
Zip : 30064-2567
Country : US
Telephone Number : 205-899-0448
Fax Number :
Provider Business Practice Location Address
First Line : 5000 THAYER CTR STE C
Second Line :
City : OAKLAND
State : MD
Zip : 21550-1139
Country : US
Telephone Number : 205-899-0448
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2009
Last Update Date : 11/04/2024

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