Healthcare Provider Details

I. General information

NPI: 1124597497
Provider Name (Legal Business Name): KIMBERLY WILLIAMS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 DENNIS AVE
SILVER SPRING MD
20902-3827
US

IV. Provider business mailing address

14842 LONDON LN
BOWIE MD
20715-2545
US

V. Phone/Fax

Practice location:
  • Phone: 240-740-3290
  • Fax: 301-649-8266
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13556
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: