Provider Demographics
NPI:1881706653
Name:WILLMOTT, KIMBERLY
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:WILLMOTT
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 1:2221 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3608
Mailing Address - Country:US
Mailing Address - Phone:619-297-8111
Mailing Address - Fax:619-220-0437
Practice Address - Street 1:2221 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3608
Practice Address - Country:US
Practice Address - Phone:619-297-8111
Practice Address - Fax:619-220-0437
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44380106H00000X
NY000604106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist