Provider Demographics
NPI:1083959456
Name:KIMBERLY J. CARR, L.C.S.W., P.C.
Entity Type:Organization
Organization Name:KIMBERLY J. CARR, L.C.S.W., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-897-8970
Mailing Address - Street 1:13164 CENTERPOINTE WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5288
Mailing Address - Country:US
Mailing Address - Phone:703-897-8970
Mailing Address - Fax:703-897-9732
Practice Address - Street 1:13164 CENTERPOINTE WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5288
Practice Address - Country:US
Practice Address - Phone:703-897-8970
Practice Address - Fax:703-897-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty