Kimberly Wilson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC50079505 Issued in DC

Practice address

6210 Belcrest Rd Apt 1228
Hyattsville, MD 20782-2967

Phone

(718) 877-0633

NPI assigned

Jan 15, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kimberly D'Nae Wilson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Boldly Whole, LLC

  • Adult Mental Health Clinic/Center
  • Lanham, MD
  • NPI 1386331478
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1083036701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 BELCREST RD APT 1228",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207822967",
            "telephone_number": "718-877-0633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6210 BELCREST RD APT 1228",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207822967",
            "telephone_number": "718-877-0633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIMBERLY",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-15",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC50079505",
            "primary": true
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "DC",
            "license": "LC50079505",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "WILSON",
            "middle_name": "D'NAE",
            "credential": "LICSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Tahani Laila Williams, MD
• Kedra S Williamson
• Christine N Wilson
• David Gerard Wilson, CAC-AD
• Kerionna Wilson
• Richard Wilson, O.T.
• Robert H Wilson, MD
• Jeffrey Daniel Winston, D.C.
• Samuel Woldemichael
• Eyob Belay Woldetnsae

• Clinical Social Worker in Hyattsville, MD
• Providers in Hyattsville, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.