Provider Demographics
NPI:1255718821
Name:EWING, KIMBERLY M (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:M
Last Name:EWING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 40TH ST STE 324
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2109
Mailing Address - Country:US
Mailing Address - Phone:443-595-7791
Mailing Address - Fax:844-591-0914
Practice Address - Street 1:711 W 40TH ST STE 324
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2109
Practice Address - Country:US
Practice Address - Phone:443-595-7791
Practice Address - Fax:844-591-0914
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-02
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03441103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling