Provider Demographics
NPI:1033304670
Name:CARR, KIMBERLY JO (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:CARR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 OSAGE ST
Mailing Address - Street 2:404
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2607
Mailing Address - Country:US
Mailing Address - Phone:703-824-8248
Mailing Address - Fax:703-824-8212
Practice Address - Street 1:1707 OSAGE ST
Practice Address - Street 2:404
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2607
Practice Address - Country:US
Practice Address - Phone:703-824-8248
Practice Address - Fax:703-824-8212
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW80011041C0700X
VA09040016891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical