Provider Demographics
NPI:1477343093
Name:WASHINGTON, KIMBERLEY A (PPSC, CWA)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:A
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:PPSC, CWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N A ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3516
Mailing Address - Country:US
Mailing Address - Phone:805-743-3000
Mailing Address - Fax:
Practice Address - Street 1:320 N J ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5925
Practice Address - Country:US
Practice Address - Phone:805-742-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230138353101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool