| Kimyatta Anderson | |
|
3707 N Main St Farmville NC 27828-1486 | |
| (252) 753-5100 | |
| (252) 753-5121 |
| Full Name | Kimyatta Anderson |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3707 N Main St, Farmville, North Carolina |
| Authorized Official Name and Position | Kimyatta Anderson (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2527535100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kimyatta Anderson Po Box 4204 Greenville NC 27836-2204 Ph: (252) 753-5100 | Kimyatta Anderson 3707 N Main St Farmville NC 27828-1486 Ph: (252) 753-5100 |
| NPI Number | 1730442294 |
|---|---|
| Provider Enumeration Date | 06/20/2012 |
| Last Update Date | 06/21/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730442294 | NPI | - | NPPES |
| 6106660 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C005612 (North Carolina) | Primary |
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