Provider Demographics
NPI:1447717988
Name:WHEELER, KIMBERLY C (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:C
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 WIDOWS CARE
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1053
Mailing Address - Country:US
Mailing Address - Phone:443-845-2545
Mailing Address - Fax:
Practice Address - Street 1:1500 IMLA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6142
Practice Address - Country:US
Practice Address - Phone:410-396-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD118041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical