Individual
ALEXA NICHOLE KIDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4125 TEMESCAL ST, FAIR OAKS, CA 95628-7558
(916) 877-6894
Mailing address
5716 FOLSOM BLVD # 276, SACRAMENTO, CA 95819-4608
(801) 649-9632
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
106466
CA
Other
Enumeration date
01/14/2022
Last updated
01/14/2022
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