Provider Demographics
NPI:1376214502
Name:DAILEY, KIYANA (LMFT)
Entity type:Individual
Prefix:
First Name:KIYANA
Middle Name:
Last Name:DAILEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KIYANA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:2658 DURHAM RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4259
Mailing Address - Country:US
Mailing Address - Phone:510-604-8058
Mailing Address - Fax:
Practice Address - Street 1:2658 DURHAM RIDGE PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4259
Practice Address - Country:US
Practice Address - Phone:510-604-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 106S00000X
CA154336106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist