Provider Demographics
NPI:1396272563
Name:SANBORN, KIMBERLY MICHELLE (LMHCA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:SANBORN
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MICHELLE
Other - Last Name:VAN DE WATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHCA
Mailing Address - Street 1:4109 INGLESIDE LOOP SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-2107
Mailing Address - Country:US
Mailing Address - Phone:530-604-7193
Mailing Address - Fax:
Practice Address - Street 1:4109 INGLESIDE LOOP SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2107
Practice Address - Country:US
Practice Address - Phone:530-604-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60785788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health