Provider Demographics
NPI:1750597589
Name:WIMBERLY, ADONA IRENE (PHD, LCADC)
Entity type:Individual
Prefix:DR
First Name:ADONA
Middle Name:IRENE
Last Name:WIMBERLY
Suffix:
Gender:F
Credentials:PHD, LCADC
Other - Prefix:DR
Other - First Name:ADONA
Other - Middle Name:IRENE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9565 LONG LOOK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3241
Mailing Address - Country:US
Mailing Address - Phone:443-621-5355
Mailing Address - Fax:
Practice Address - Street 1:1447 YORK RD STE 506
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6022
Practice Address - Country:US
Practice Address - Phone:410-825-2281
Practice Address - Fax:410-825-2280
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04227103T00000X, 103TC0700X
MDLCA124101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)