MEDICARE: MRS. KIMBERLY EASTMAN WILLIAMS 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	C003859	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	128JC	OTHER	NC	BLUE CROSS BLUE SHEILD NC

General Provider Information

NPI Number	:	1578539722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY EASTMAN WILLIAMS LCSW

Provider Business Mailing Address
First Line	:	3725 NATIONAL DR
Second Line	:	SUITE 114
City	:	RALEIGH
State	:	NC
Zip	:	27612-4066
Country	:	US
Telephone Number	:	919-784-0205
Fax Number	:	919-784-0250

Provider Business Practice Location Address
First Line	:	3725 NATIONAL DR
Second Line	:	SUITE 114
City	:	RALEIGH
State	:	NC
Zip	:	27612-4066
Country	:	US
Telephone Number	:	919-784-0205
Fax Number	:	919-784-0250

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	07/08/2007

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