Provider Demographics
NPI:1083866230
Name:NELSON, KIMBERLY SOPHIA (MS MFT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SOPHIA
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:SOPHIA
Other - Last Name:KEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2525 CAMINO DEL RIO S STE 315
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3784
Mailing Address - Country:US
Mailing Address - Phone:619-280-3430
Mailing Address - Fax:
Practice Address - Street 1:325 CARLSBAD VILLAGE DR
Practice Address - Street 2:SUITE F-2
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2928
Practice Address - Country:US
Practice Address - Phone:619-280-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45871106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist