Provider Demographics
NPI:1770959603
Name:BERLIN, KIMBERLEY L (LSW, CSAC, SAP, NCRC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:L
Last Name:BERLIN
Suffix:
Gender:F
Credentials:LSW, CSAC, SAP, NCRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42395 RYAN RD
Mailing Address - Street 2:SUITE 112-116
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4863
Mailing Address - Country:US
Mailing Address - Phone:703-528-8668
Mailing Address - Fax:
Practice Address - Street 1:10640 PAGE AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4000
Practice Address - Country:US
Practice Address - Phone:703-528-8668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102772101YA0400X
VA0903001841104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker