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General NPI Number Information
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NPI Number | 1588217699
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Entity Type | Organization
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Legal Business Name | KIMILA DEFLANDERS LCSW LLC
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 1390 29TH AVE STE B
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City | GULFPORT
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State | MS
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Zip | 39501-1945
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Country | US
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Telephone | 601-557-2185
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Fax | 228-220-4303
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Provider Business Mailing Address
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Address Line | PO BOX 8024
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City | BILOXI
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State | MS
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Zip | 39535-8024
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Country | US
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Telephone | 601-557-2185
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Fax | 228-220-4303
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. KIMILA DEFLANDERS
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Credential | LCSW
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Telephone | 601-557-2185
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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 |
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License Number State |
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