Provider Demographics
NPI:1497244511
Name:SULLIVAN, KIMBERLY PAIGE (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PAIGE
Last Name:SULLIVAN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3673 MANHATTAN DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-6109
Mailing Address - Country:US
Mailing Address - Phone:423-503-8633
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 748465
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30374-8465
Practice Address - Country:US
Practice Address - Phone:229-800-9695
Practice Address - Fax:617-807-0958
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW008007104100000X
GACSW0073021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker