Provider Demographics
NPI:1144197104
Name:BLAIR, KIMBERLY ANNE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:BLAIR
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 1:2204 GARNET AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3771
Mailing Address - Country:US
Mailing Address - Phone:619-333-0532
Mailing Address - Fax:
Practice Address - Street 1:2204 GARNET AVE STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3771
Practice Address - Country:US
Practice Address - Phone:619-333-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist