Provider Demographics
NPI:1508560145
Name:KIMMINS, WILLIAM (LPC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KIMMINS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 PRIEST BRIDGE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2472
Mailing Address - Country:US
Mailing Address - Phone:443-937-7089
Mailing Address - Fax:443-292-4570
Practice Address - Street 1:120 WATERFRONT ST STE 420
Practice Address - Street 2:
Practice Address - City:NATIONAL HARBOR
Practice Address - State:MD
Practice Address - Zip Code:20745-1122
Practice Address - Country:US
Practice Address - Phone:410-635-1294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13889101YM0800X
KSLPC04287101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional