Provider Demographics
NPI:1679609242
Name:MCALISTER, KIM AILEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:AILEEN
Last Name:MCALISTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 ROBINSON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4437
Mailing Address - Country:US
Mailing Address - Phone:619-298-0738
Mailing Address - Fax:
Practice Address - Street 1:1239 ROBINSON AVE APT 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4437
Practice Address - Country:US
Practice Address - Phone:619-298-0738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS175161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS17516OtherLICENSE NUMBER