Kimberley Ann Coulson, RADT I

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

RH0013340624 Issued in CA

Practice address

1750 5TH Ave
San Diego, CA 92101-2754

Phone

(619) 255-5058

Fax

(619) 269-8349

NPI assigned

Dec 20, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1703030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1649049560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 5TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012754",
            "telephone_number": "619-255-5058",
            "fax_number": "619-269-8349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COULSON",
        "first_name": "KIMBERLEY",
        "middle_name": "ANN",
        "credential": "RADT I",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-20",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-MLEBUO",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "RH0013340624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila Star Coulbourn, CMT
• James Donald Coullahan, MD
• Jessica Michelle Coullahan, MD
• Coulsby Chiropractic, P.C.
• Delora Ann Coulson
• Laura Elizabeth Coulson, MD
• Amelia Noelle Coultas, MA CCC-SLP
• Andra Alise Coulter, MFT
• Elizabeth Anne Coulter, M.D
• Counseling Associates Inc

• Addiction (Substance Use Disorder) Counselor in San Diego, CA
• Providers in San Diego, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.