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General NPI Number Information
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NPI Number | 1871398990
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Entity Type | Individual
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Provider Name | LAURA CAMILLE KIMBALL PPS
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Gender | Female
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 1500 D ST
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City | ANTIOCH
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State | CA
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Zip | 94509-2346
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Country | US
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Telephone | 541-821-0063
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 D ST
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City | ANTIOCH
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State | CA
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Zip | 94509-2346
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Country | US
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Telephone | 925-779-7400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 250031648
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License Number State | CA
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