Provider Demographics
NPI:1700379153
Name:POOLE, KHALIMAH
Entity Type:Individual
Prefix:MRS
First Name:KHALIMAH
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KHALIMAH
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1205 BRISTOL STATION CT
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-3091
Mailing Address - Country:US
Mailing Address - Phone:201-844-5388
Mailing Address - Fax:
Practice Address - Street 1:166 MAIN ST
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3104
Practice Address - Country:US
Practice Address - Phone:201-844-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health