Provider Demographics
NPI:1447424643
Name:KIM, EUNICE E (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:EUNICE
Middle Name:E
Last Name:KIM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 E GARVEY ST
Mailing Address - Street 2:STE 102
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3677
Mailing Address - Country:US
Mailing Address - Phone:626-967-6421
Mailing Address - Fax:626-967-9670
Practice Address - Street 1:1175 E GARVEY ST
Practice Address - Street 2:STE 102
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3677
Practice Address - Country:US
Practice Address - Phone:626-967-6421
Practice Address - Fax:626-967-9670
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS242961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical