Provider Demographics
NPI:1588184857
Name:WILLIAMS COLLINS, KIMBERLY Y
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:Y
Last Name:WILLIAMS COLLINS
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 1:5154 STAGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3118
Mailing Address - Country:US
Mailing Address - Phone:901-372-9133
Mailing Address - Fax:901-372-1015
Practice Address - Street 1:910 MADISON AVE STE 922
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-3118
Practice Address - Country:US
Practice Address - Phone:901-448-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2914103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ034995Medicaid
MS08650505Medicaid
AR228484719Medicaid