Provider Demographics
NPI:1053893677
Name:KIDD, VICTOR DION (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:DION
Last Name:KIDD
Suffix:
Gender:M
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 COUNSELORS WAY APT 305
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8667
Mailing Address - Country:US
Mailing Address - Phone:202-701-8922
Mailing Address - Fax:
Practice Address - Street 1:100 STONE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6588
Practice Address - Country:US
Practice Address - Phone:855-268-8880
Practice Address - Fax:855-588-2532
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12663104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker