Provider Demographics
NPI:1053829572
Name:WALKER, KIMBERLY LYNN (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:LYNN
Other - Last Name:JIVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:9507 VERMELL PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-6008
Mailing Address - Country:US
Mailing Address - Phone:443-306-5678
Mailing Address - Fax:
Practice Address - Street 1:9507 VERMELL PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-6008
Practice Address - Country:US
Practice Address - Phone:443-306-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD235601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD383876389Medicaid