Provider Demographics
NPI:1346866951
Name:KIM, CHI EUN (LPC, MMT, MT-BC)
Entity Type:Individual
Prefix:
First Name:CHI EUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LPC, MMT, MT-BC
Other - Prefix:
Other - First Name:BEATRICE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, MMT, MT-BC
Mailing Address - Street 1:VEVA BUILDING 12, 1777 SENTRY PKWY W
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422
Mailing Address - Country:US
Mailing Address - Phone:267-585-4402
Mailing Address - Fax:
Practice Address - Street 1:1364 WELSH RD STE C-1
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1913
Practice Address - Country:US
Practice Address - Phone:240-688-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012418101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional