Provider Demographics
NPI:1467580605
Name:PIASECKI, KIM WEIST (MS, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:WEIST
Last Name:PIASECKI
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13240 EXECUTIVE PARK TER
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2640
Mailing Address - Country:US
Mailing Address - Phone:301-355-0450
Mailing Address - Fax:301-515-1937
Practice Address - Street 1:13240 EXECUTIVE PARK TER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2640
Practice Address - Country:US
Practice Address - Phone:301-355-0450
Practice Address - Fax:301-515-1937
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional