Provider Demographics
NPI:1992542617
Name:ISMAIL, KIMBERLY D (MS, BCH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:MS, BCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 HARBOR DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODBRDIGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192
Mailing Address - Country:US
Mailing Address - Phone:571-480-4613
Mailing Address - Fax:
Practice Address - Street 1:13000 HARBOR DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODBRDIGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:571-480-4613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty