Most Relevant Information
Provider Data
| NPI Number: | 1003380049 |
| Provider Name: | KIMBERLY VERMILLION FOGARTY JD, MA, BC-TMH |
| Entity Type: | Individual |
| Taxonomy Code: | 106H00000X |
| Specialty: | Marriage & Family Therapist |
| License Number: | 1600014 |
Most Important Dates
| Enumeration Date: | 01/13/2019 |
| Last Updated: | 01/13/2019 |
Provider Practice Location
580 BROADWAY ST STE 208
LAGUNA BEACH
CA
926514311
Practice Location Phone/Fax
| Phone: | 9494249755 |
| Fax: | 9494880344 |
Provider Mailing Location
8 PACIFICO
LAGUNA NIGUEL
CA
926774242
Provider Mailing Phone/Fax
| Phone: | 9494225885 |
| Fax: |