Provider Demographics
NPI:1730412446
Name:COLTON, KIMBERLY NICOLE
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:COLTON
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 1:4608 GUAVA AVE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2942
Mailing Address - Country:US
Mailing Address - Phone:562-212-5471
Mailing Address - Fax:
Practice Address - Street 1:2100 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2624
Practice Address - Country:US
Practice Address - Phone:714-245-6881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-13
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical