Healthcare Provider Details

I. General information

NPI: 1902812357
Provider Name (Legal Business Name): DONNA TOBY KIMMEL PH.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA TOBY KIMMEL PH.D.

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10114 PARKWOOD DR
BETHESDA MD
20814-4034
US

IV. Provider business mailing address

10114 PARKWOOD DR
BETHESDA MD
20814-4034
US

V. Phone/Fax

Practice location:
  • Phone: 240-277-4427
  • Fax: 301-530-1250
Mailing address:
  • Phone: 240-277-4427
  • Fax: 301-530-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC2009
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2009
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1926
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: