Provider Demographics
NPI:1184847501
Name:MCKIM, DARLA KAY (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DARLA
Middle Name:KAY
Last Name:MCKIM
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MISS
Other - First Name:DARLA
Other - Middle Name:KAY
Other - Last Name:WALSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2325 177TH ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-1722
Mailing Address - Country:US
Mailing Address - Phone:219-270-3395
Mailing Address - Fax:708-895-7602
Practice Address - Street 1:5578 W 1100 N
Practice Address - Street 2:
Practice Address - City:WHEATFIELD
Practice Address - State:IN
Practice Address - Zip Code:46392-7012
Practice Address - Country:US
Practice Address - Phone:219-270-3395
Practice Address - Fax:708-895-7602
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33004500A104100000X
IN34007224A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker