Provider Demographics
NPI:1952515413
Name:DIAMOND-BERRY, KIMBERLY P (PHD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:P
Last Name:DIAMOND-BERRY
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 1:1707 BELLE VIEW BLVD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-6727
Mailing Address - Country:US
Mailing Address - Phone:703-615-6181
Mailing Address - Fax:703-768-6264
Practice Address - Street 1:1707 BELLE VIEW BLVD
Practice Address - Street 2:SUITE C-1
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-6727
Practice Address - Country:US
Practice Address - Phone:703-615-6181
Practice Address - Fax:703-768-6264
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002868103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent