Jimenez, Carmen Kadesha

Jimenez, Carmen Kadesha is an sole proprietor health care provider with primary practice located at 4460 Washington Rd Ste 19 , Evans GA 30809-3963. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Jimenez, Carmen Kadesha can be contacted via phone (980) 275-2505.

Contact Information

Primary practice address
4460 Washington Rd Ste 19 Evans GA 30809-3963
Phone: (980) 275-2505
Fax: (207) 591-9801
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X SW.10478 CP South Carolina
Behavioral Health & Social Service Providers / Mental Health 101YM0800X P007687 North Carolina
Behavioral Health & Social Service Providers / Clinical 1041C0700X P007687 North Carolina
Behavioral Health & Social Service Providers / Clinical 1041C0700X SW.10478 CP South Carolina

Profile Details

NPI number 1215280904
LBN Legal business name Jimenez, Carmen Kadesha
Credentials MSW, LCSW, LISW-CP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 18th, 2012
Last updated Feb 27th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215280904 NPPES
Georgia MEDICAID 003213277A
Georgia MEDICAID SW1128

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