Provider Demographics
NPI:1043591563
Name:KIM, YOUNG KYONG (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:KYONG
Last Name:KIM
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:DR
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LMFT
Mailing Address - Street 1:4530 SOUTH BERKELEY LAKE ROAD
Mailing Address - Street 2:PATHWAY CENTER FOR PSYCHOTHERAPY
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071
Mailing Address - Country:US
Mailing Address - Phone:770-446-5642
Mailing Address - Fax:770-446-5643
Practice Address - Street 1:4530 SOUTH BERKELEY LA
Practice Address - Street 2:PATHWAY CENTER FOR PSYCHOTHERAPY
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:770-446-5642
Practice Address - Fax:770-446-5643
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001237106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist