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General NPI Number Information
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NPI Number | 1962746065
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Entity Type | Individual
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Provider Name | KIMBERLY ANGELA VANKIRK LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 2201 SOUTH AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-7025
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Country | US
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Telephone | 530-543-5623
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Fax | 530-541-5738
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Provider Business Mailing Address
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Address Line | PO BOX 3231
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City | STATELINE
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State | NV
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Zip | 89449-3231
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Country | US
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Telephone | 530-721-7716
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW68107
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License Number State | CA
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