MEDICARE: KIM GOFORTH SIMPSON 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	18704	SC
2	1041C0700X	Clinical Social Worker	C016948	NC
3	1041C0700X	Clinical Social Worker	TPSW4034	FL
4	1041C0700X	Clinical Social Worker	35968	MN

General Provider Information

NPI Number	:	1720606783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM GOFORTH SIMPSON LCSW

Provider Business Mailing Address
First Line	:	1050 CAMBROOK CT
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-0504
Country	:	US
Telephone Number	:	980-355-1429
Fax Number	:	877-940-3260

Provider Business Practice Location Address
First Line	:	1050 CAMBROOK CT
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-0504
Country	:	US
Telephone Number	:	980-355-1429
Fax Number	:	877-940-3260

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

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	04/10/2026

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