Provider Demographics
NPI:1447999891
Name:WALKER - DEMATTEI, KIMBERLY ANNE (LMFT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:WALKER - DEMATTEI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 N DUTTON AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4658
Mailing Address - Country:US
Mailing Address - Phone:707-303-3201
Mailing Address - Fax:707-526-8310
Practice Address - Street 1:1160 N DUTTON AVE STE 230
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4658
Practice Address - Country:US
Practice Address - Phone:707-303-3201
Practice Address - Fax:707-526-8310
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist