Provider Demographics
NPI:1740597806
Name:KIMMELL, ALISSA WARREN
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:WARREN
Last Name:KIMMELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5297 COLLEGE AVE SUITE 106
Mailing Address - Street 2:OAKLAND, CA.
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618
Mailing Address - Country:US
Mailing Address - Phone:510-394-2492
Mailing Address - Fax:
Practice Address - Street 1:5297 COLLEGE AVE SUITE 106
Practice Address - Street 2:OAKLAND, CA.
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618
Practice Address - Country:US
Practice Address - Phone:510-394-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA671731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical