Provider Demographics
NPI:1194767889
Name:DEFLANDERS, KIMILA R (LCSW)
Entity type:Individual
Prefix:MS
First Name:KIMILA
Middle Name:R
Last Name:DEFLANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VETERANS AVE
Mailing Address - Street 2:SOCIAL WORK SERVICE #122
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2410
Mailing Address - Country:US
Mailing Address - Phone:228-523-5000
Mailing Address - Fax:
Practice Address - Street 1:1390 29TH AVE STE B
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-1945
Practice Address - Country:US
Practice Address - Phone:601-557-2185
Practice Address - Fax:228-220-4303
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC79611041C0700X
AL3729C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical