Provider Demographics
NPI:1124573910
Name:ONG, KIMBERLY O'TOOLE (QASP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:O'TOOLE
Last Name:ONG
Suffix:
Gender:F
Credentials:QASP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 WYNNGATE DR
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-6394
Mailing Address - Country:US
Mailing Address - Phone:804-503-7621
Mailing Address - Fax:
Practice Address - Street 1:169 MITTIE HADDOCK DR
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-9379
Practice Address - Country:US
Practice Address - Phone:800-991-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst