Provider Demographics
NPI:1174719256
Name:KIMBROUGH, CAROL THOMAS (MFT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:THOMAS
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 PEARL ST
Mailing Address - Street 2:COMMUNITY HUMAN SERVICES COUNSELING CENTER
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940
Mailing Address - Country:US
Mailing Address - Phone:831-373-4775
Mailing Address - Fax:
Practice Address - Street 1:590 PEARL ST
Practice Address - Street 2:COMMUNITY HUMAN SERVICES COUNSELING CENTER
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-373-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist