Basic Information
| Provider Information | |||||||||
| NPI: | 1740298199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KITCHENS | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LISW-C, CEAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 538622 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303538622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107429243 | ||||||||
| FaxNumber: | 8887461787 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 DUTCH FORK RD | ||||||||
| Address2: | |||||||||
| City: | CHAPIN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290367576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107429243 | ||||||||
| FaxNumber: | 8887461787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 12/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 05504 | MD | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 11791 | SC | Y | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 11791 | SC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 547530-01 | 01 | MD | BCBS | OTHER | PHCS2236109 | 01 | MD | PHCS | OTHER | 000395600 | 05 | MD | MEDICAID | 121738 | 01 | MD | JOHN HOPKINS HEALTCARE | OTHER |