Provider Demographics
NPI:1306388657
Name:HEATH, KIMBERLY CARDEN (MAED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CARDEN
Last Name:HEATH
Suffix:
Gender:F
Credentials:MAED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BULIFANTS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5711
Mailing Address - Country:US
Mailing Address - Phone:757-645-3860
Mailing Address - Fax:
Practice Address - Street 1:111 BULIFANTS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5711
Practice Address - Country:US
Practice Address - Phone:757-645-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000877103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst