Provider Demographics
NPI:1679133367
Name:WILLIAMS, KIMBERLY SYLVIA (MS, PC-IT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SYLVIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, PC-IT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3021 HOLMES AVE S APT 204
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6600 FRANCE AVE S STE 425
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1808
Practice Address - Country:US
Practice Address - Phone:952-243-8300
Practice Address - Fax:952-243-8301
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4159-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional