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General NPI Number Information
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NPI Number | 1649821752
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Entity Type | Individual
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Provider Name | ELIZABETH KIM ATR-BC, LPC, GC-C
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Gender | Female
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 10617 JONES ST, FAIRFAX, VA 22030 301B
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City | FAIRFAX
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State | VA
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Zip | 22030
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Country | US
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Telephone | 202-670-3505
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Fax |
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Provider Business Mailing Address
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Address Line | 10617 JONES ST, FAIRFAX, VA 22030 301B
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City | FAIRFAX
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State | VA
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Zip | 22030
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Country | US
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Telephone | 631-848-5879
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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 | PRC15075
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License Number State | DC
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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 | 0701013741
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License Number State | VA
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