Basic Information
| Provider Information | |||||||||
| NPI: | 1194767889 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEFLANDERS | ||||||||
| FirstName: | KIMILA | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 VETERANS AVE | ||||||||
| Address2: | SOCIAL WORK SERVICE #122 | ||||||||
| City: | BILOXI | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395312410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285235000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1390 29TH AVE STE B | ||||||||
| Address2: | |||||||||
| City: | GULFPORT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395011945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015572185 | ||||||||
| FaxNumber: | 2282204303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C7961 | MS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.