Healthcare Provider Details

I. General information

NPI: 1952937641
Provider Name (Legal Business Name): KIMBERLY SNOW LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 E STREET BLDG 1122
OCEANSIDE CA
92055
US

IV. Provider business mailing address

1108 E STREET
OCEANSIDE CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 442-466-5183
  • Fax:
Mailing address:
  • Phone: 442-466-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: