Provider Demographics
NPI:1831328251
Name:KINKELAAR, DEBRA DAVIS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:DAVIS
Last Name:KINKELAAR
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 1:2 ROUNDUP RD.
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90274-0000
Mailing Address - Country:US
Mailing Address - Phone:310-594-3790
Mailing Address - Fax:
Practice Address - Street 1:2 ROUNDUP RD.
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS
Practice Address - State:CA
Practice Address - Zip Code:90274-5233
Practice Address - Country:US
Practice Address - Phone:310-594-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS132791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical