Provider Demographics
NPI:1528289303
Name:KINLAW, ANNE BASS (LCSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:BASS
Last Name:KINLAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:1801 SCUFFLE HILL DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-0004
Mailing Address - Country:US
Mailing Address - Phone:443-235-5392
Mailing Address - Fax:
Practice Address - Street 1:1801 SCUFFLE HILL DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-0004
Practice Address - Country:US
Practice Address - Phone:443-235-5392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0067671041C0700X
MD11794106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD241LMedicare ID - Type Unspecified