Provider Demographics
NPI:1154944163
Name:KIMCARES WELLNESS SERVICES, LLC
Entity type:Organization
Organization Name:KIMCARES WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:CECELIA
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LICSW, LCSW
Authorized Official - Phone:301-363-9835
Mailing Address - Street 1:2957 FESTIVAL WAY STE 123
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2959
Mailing Address - Country:US
Mailing Address - Phone:301-202-1759
Mailing Address - Fax:
Practice Address - Street 1:15854 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-2220
Practice Address - Country:US
Practice Address - Phone:202-875-9770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1285143826OtherNPI