Provider Demographics
NPI:1548021272
Name:KIMMINS, AMBER JANEICE (ASW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JANEICE
Last Name:KIMMINS
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14254 POWAY RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4929
Mailing Address - Country:US
Mailing Address - Phone:510-395-2114
Mailing Address - Fax:
Practice Address - Street 1:14254 POWAY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4929
Practice Address - Country:US
Practice Address - Phone:510-395-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104987104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker