Provider Demographics
NPI:1588315469
Name:WILLIAMS, KIMBERLY (RBT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6518 CORKLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-1734
Mailing Address - Country:US
Mailing Address - Phone:443-416-5523
Mailing Address - Fax:
Practice Address - Street 1:6518 CORKLEY RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-1734
Practice Address - Country:US
Practice Address - Phone:443-416-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-21-197750106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician