Provider Demographics
NPI:1942611298
Name:WASHINGTON, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WASHINGTON
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 1:1050 W 8TH AVE
Mailing Address - Street 2:APT. 114
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3471
Mailing Address - Country:US
Mailing Address - Phone:480-907-9356
Mailing Address - Fax:
Practice Address - Street 1:1050 W 8TH AVE
Practice Address - Street 2:APT. 114
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3471
Practice Address - Country:US
Practice Address - Phone:480-907-9356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010605671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical