Provider Demographics
NPI:1003238023
Name:WIMMER, KIRSTEN MAY (LMFT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MAY
Last Name:WIMMER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:DEGIACOMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11622 EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2051
Mailing Address - Country:US
Mailing Address - Phone:619-549-0329
Mailing Address - Fax:
Practice Address - Street 1:11622 EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2051
Practice Address - Country:US
Practice Address - Phone:619-549-0329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist