Provider Demographics
NPI:1306101530
Name:CADWALLADER, KIMBERLY S (LMHC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:CADWALLADER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:2330 EASTGATE ST
Mailing Address - Street 2:STE 201
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2557
Mailing Address - Country:US
Mailing Address - Phone:509-593-9667
Mailing Address - Fax:
Practice Address - Street 1:2330 EASTGATE ST
Practice Address - Street 2:STE 201
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2557
Practice Address - Country:US
Practice Address - Phone:509-593-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2017-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor