Provider Demographics
NPI:1316576499
Name:KIMBERLEY ANN HOULIHAN LLC
Entity Type:Organization
Organization Name:KIMBERLEY ANN HOULIHAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOULIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW C
Authorized Official - Phone:410-430-9580
Mailing Address - Street 1:30339 FOSKEY LN
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2000
Mailing Address - Country:US
Mailing Address - Phone:410-430-9580
Mailing Address - Fax:
Practice Address - Street 1:30550 GORDY MILL RD
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:MD
Practice Address - Zip Code:21875-2043
Practice Address - Country:US
Practice Address - Phone:410-430-9580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)