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General NPI Number Information
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NPI Number | 1083959456
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Entity Type | Organization
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Legal Business Name | KIMBERLY J. CARR, L.C.S.W., P.C.
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Dates
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Enumeration Date | 12/11/2012
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 13164 CENTERPOINTE WAY SUITE 202
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City | WOODBRIDGE
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State | VA
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Zip | 22193-5288
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Country | US
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Telephone | 703-897-8970
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Fax | 703-897-9732
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Provider Business Mailing Address
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Address Line | 13164 CENTERPOINTE WAY SUITE 202
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City | WOODBRIDGE
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State | VA
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Zip | 22193-5288
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Country | US
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Telephone | 703-897-8970
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Fax | 703-897-9732
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. KIMBERLY JO CARR
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Credential | L.C.S.W.
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Telephone | 703-897-8970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904001689
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License Number State | VA
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