Provider Demographics
NPI:1568741163
Name:LIM, DAVID J (LICSW, MBA, MSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:LIM
Suffix:
Gender:M
Credentials:LICSW, MBA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 W GALER ST
Mailing Address - Street 2:3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3284
Mailing Address - Country:US
Mailing Address - Phone:310-740-7309
Mailing Address - Fax:
Practice Address - Street 1:914 W GALER ST
Practice Address - Street 2:3
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3284
Practice Address - Country:US
Practice Address - Phone:310-740-7309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601771171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical