| Doctor Name: | KIMBERLAND DALE VANHORN |
| NPI Number: | 1063669489 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RASI |
| License Number: | RI-V0808221354 |
| Business Practice Address: | 6885 Old Highway 53 Clearlake, CA - 954226470 |
| Business Phone Number: | 7079953235 |
| Business Fax Number: | |
| Mailing Address: | Po Box 6470, CLEARLAKE |
| State: | CA |
| Postal Code: | 954226470 |
| Phone Number: | 7079953235 |
| Fax Number: | |
| NPI Enumeration Date: | 08/27/2008 |
| NPI Last Update Date: | 08/27/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | RI-V0808221354 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |