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General NPI Number Information
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NPI Number | 1154020071
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Entity Type | Individual
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Provider Name | SALLY KIM LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 504 MAIN ST
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5587
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Country | US
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Telephone | 301-591-6830
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Fax |
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Provider Business Mailing Address
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Address Line | 8010 GRAMERCY BLVD APT 435
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City | ROCKVILLE
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State | MD
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Zip | 20855-2365
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Country | US
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Telephone | 301-906-9804
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LGP11987
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC15113
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License Number State | MD
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