Provider Demographics
NPI:1245767268
Name:WILLIAMS, KIMBERLY RENEA (LMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENEA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 OVERTON DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2507
Mailing Address - Country:US
Mailing Address - Phone:202-277-2193
Mailing Address - Fax:
Practice Address - Street 1:5850 WATERLOO RD STE 230
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1943
Practice Address - Country:US
Practice Address - Phone:410-757-2077
Practice Address - Fax:443-782-2342
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG102356104100000X
MDG131861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker