Healthcare Provider Details

I. General information

NPI: 1659125599
Provider Name (Legal Business Name): KIMBER LYNN THOMAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E CHURCHVILLE RD STE 300
BEL AIR MD
21014-3485
US

IV. Provider business mailing address

517 11TH AVE
PROSPECT PARK PA
19076-1304
US

V. Phone/Fax

Practice location:
  • Phone: 410-893-4600
  • Fax:
Mailing address:
  • Phone: 910-229-7274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number31310
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: