Provider Demographics
NPI:1457545907
Name:WELLS, KIMBERLY JANE (MSW LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JANE
Last Name:WELLS
Suffix:
Gender:F
Credentials:MSW LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-0157
Mailing Address - Country:US
Mailing Address - Phone:301-570-9700
Mailing Address - Fax:301-260-2838
Practice Address - Street 1:2915-B OLNEY SANDY SPRING ROAD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-3502
Practice Address - Country:US
Practice Address - Phone:301-570-7500
Practice Address - Fax:307-570-7504
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD113661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical