Provider Demographics
NPI:1699428961
Name:BROWN, KIMBERLY ARMISE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ARMISE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15934 HESPERIAN BLVD # 211
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-1540
Mailing Address - Country:US
Mailing Address - Phone:510-878-0160
Mailing Address - Fax:
Practice Address - Street 1:641 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1620
Practice Address - Country:US
Practice Address - Phone:510-878-0160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional