Provider Demographics
NPI:1013060771
Name:WHITEFORD, KIMBERLY D (MA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:WHITEFORD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 MOREHOUSE DR STE 160
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4713
Mailing Address - Country:US
Mailing Address - Phone:619-627-9141
Mailing Address - Fax:
Practice Address - Street 1:5465 MOREHOUSE DR STE 160
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4713
Practice Address - Country:US
Practice Address - Phone:619-627-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123600101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty