Provider Demographics
NPI:1225552045
Name:KIM DOUGLASS, ANNA HAEUN (LICSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:HAEUN
Last Name:KIM DOUGLASS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:HAEUN
Other - Middle Name:ANNA
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSWA
Mailing Address - Street 1:550 222ND PL SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7111
Mailing Address - Country:US
Mailing Address - Phone:425-369-1111
Mailing Address - Fax:425-369-1112
Practice Address - Street 1:550 222ND PL SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7111
Practice Address - Country:US
Practice Address - Phone:425-369-1111
Practice Address - Fax:425-369-1112
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WALW611554441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical