Healthcare Provider Details

I. General information

NPI: 1588582282
Provider Name (Legal Business Name): KIMARA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 W 8TH ST
WILMINGTON DE
19805-3152
US

IV. Provider business mailing address

1613 W 8TH ST
WILMINGTON DE
19805-3152
US

V. Phone/Fax

Practice location:
  • Phone: 302-498-3796
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: