Provider Demographics
NPI:1962190892
Name:JOHNS, KIMBERLY S (RBT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:JOHNS
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 1:170 SEMINOLE LN
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-8009
Mailing Address - Country:US
Mailing Address - Phone:229-560-8691
Mailing Address - Fax:
Practice Address - Street 1:170 SEMINOLE LN
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-8009
Practice Address - Country:US
Practice Address - Phone:229-560-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-20-138102106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician