Provider Demographics
NPI:1598120198
Name:SANDERS, KIMBERLY J
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:J
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:SANDERS
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:128 EAST ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5119
Mailing Address - Country:US
Mailing Address - Phone:530-889-0178
Mailing Address - Fax:530-889-8279
Practice Address - Street 1:128 EAST ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5119
Practice Address - Country:US
Practice Address - Phone:530-889-0178
Practice Address - Fax:530-889-8279
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT37203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health