Provider Demographics
NPI:1609262856
Name:WASHINGTON, KIMBERLY (LCSWC/LICSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LCSWC/LICSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SIMMONS-WASHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWC/LICSW
Mailing Address - Street 1:13905 UMBEL LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8959
Mailing Address - Country:US
Mailing Address - Phone:301-351-5871
Mailing Address - Fax:
Practice Address - Street 1:13905 UMBEL LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8959
Practice Address - Country:US
Practice Address - Phone:301-351-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC300007321041C0700X
MD102281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical