Provider Demographics
NPI:1487014817
Name:WILLIAMS, KIMBERLY ELISE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 ALTON PKWY STE 5A
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3717
Mailing Address - Country:US
Mailing Address - Phone:949-468-9723
Mailing Address - Fax:
Practice Address - Street 1:5405 ALTON PKWY STE 5A
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3717
Practice Address - Country:US
Practice Address - Phone:949-468-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW650831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical