Provider Demographics
NPI:1407568876
Name:WALSTON, KIMBERLY KAT (SWA, RBT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAT
Last Name:WALSTON
Suffix:
Gender:F
Credentials:SWA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 DILLARD HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-2595
Mailing Address - Country:US
Mailing Address - Phone:678-894-5040
Mailing Address - Fax:
Practice Address - Street 1:1482 DILLARD HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-2595
Practice Address - Country:US
Practice Address - Phone:678-894-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician