Healthcare Provider Details

I. General information

NPI: 1841650413
Provider Name (Legal Business Name): KIMBERLY ANN MILLARD SUDCC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8741 LAUREL CANYON BLVD
SUN VALLEY CA
91352-2919
US

IV. Provider business mailing address

8741 LAUREL CANYON BLVD
SUN VALLEY CA
91352-2919
US

V. Phone/Fax

Practice location:
  • Phone: 818-351-1054
  • Fax:
Mailing address:
  • Phone: 818-351-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: