Provider Demographics
NPI:1922643121
Name:WILLIAMS, KIMBERLY J (CADC, MHRT/C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CADC, MHRT/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 NO NAME POND RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-2801
Mailing Address - Country:US
Mailing Address - Phone:207-713-7879
Mailing Address - Fax:
Practice Address - Street 1:105 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7037
Practice Address - Country:US
Practice Address - Phone:207-440-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5305101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)