Healthcare Provider Details

I. General information

NPI: 1558435230
Provider Name (Legal Business Name): TOMIKKA KIMBERLY LEE LCSW 61843
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HARBOR CTR STE 240
SUISUN CITY CA
94585-2449
US

IV. Provider business mailing address

9106 CAMBRIDGE CIR
VALLEJO CA
94591-8595
US

V. Phone/Fax

Practice location:
  • Phone: 559-999-9871
  • Fax: 707-981-4350
Mailing address:
  • Phone: 559-999-9871
  • Fax: 707-981-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: