Provider Demographics
NPI:1285306506
Name:SIMSER, KIARA MARIE (SUD COUNSELOR)
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:MARIE
Last Name:SIMSER
Suffix:
Gender:F
Credentials:SUD COUNSELOR
Other - Prefix:
Other - First Name:SKYLAR
Other - Middle Name:GREY
Other - Last Name:SNOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SUD COUNSELOR
Mailing Address - Street 1:1400 N JOHNSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1651
Mailing Address - Country:US
Mailing Address - Phone:619-442-0277
Mailing Address - Fax:
Practice Address - Street 1:2049 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-4221
Practice Address - Country:US
Practice Address - Phone:619-465-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17797101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)