Provider Demographics
NPI:1144613647
Name:LONDON, KIMBERLY SHANTIA (MSW)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:SHANTIA
Last Name:LONDON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:SHANTIA
Other - Last Name:LONDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:903 W 34TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2527
Mailing Address - Country:US
Mailing Address - Phone:609-649-6190
Mailing Address - Fax:
Practice Address - Street 1:903 W 34TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2527
Practice Address - Country:US
Practice Address - Phone:609-649-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)