MEDICARE: HANEUL KIM LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1750055281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANEUL KIM LCSW

Provider Business Mailing Address
First Line	:	5400 LAUREL SPRINGS PKWY STE 203
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-6062
Country	:	US
Telephone Number	:	678-941-4855
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 LAUREL SPRINGS PKWY STE 203
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-6062
Country	:	US
Telephone Number	:	678-941-4855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2021
Last Update Date	:	01/16/2023

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Directions to “ HANEUL KIM LCSW” Practice Location

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