Provider Demographics
NPI:1841486131
Name:WILBORN, KATHEY MICHELLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHEY
Middle Name:MICHELLE
Last Name:WILBORN
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:PO BOX 5201
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-5201
Mailing Address - Country:US
Mailing Address - Phone:310-844-3431
Mailing Address - Fax:310-891-0195
Practice Address - Street 1:1225 W 190TH ST STE 205
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4336
Practice Address - Country:US
Practice Address - Phone:888-227-0649
Practice Address - Fax:888-434-7923
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS151951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical