Healthcare Provider Details

I. General information

NPI: 1215417159
Provider Name (Legal Business Name): LAUREN KIM LCPC, LCPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 COLUMBIA PIKE STE 300
SILVER SPRING MD
20901-4439
US

IV. Provider business mailing address

10770 COLUMBIA PIKE STE 300
SILVER SPRING MD
20901-4439
US

V. Phone/Fax

Practice location:
  • Phone: 301-508-2197
  • Fax:
Mailing address:
  • Phone: 301-507-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberATC279
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC11070
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701016174
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: