Provider Demographics
NPI:1457928871
Name:BORDEN, KIMBERLY (MS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BORDEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4272 WILSON LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-1263
Mailing Address - Country:US
Mailing Address - Phone:925-381-7477
Mailing Address - Fax:
Practice Address - Street 1:4272 WILSON LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-1263
Practice Address - Country:US
Practice Address - Phone:925-381-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health