Provider Demographics
NPI:1598397234
Name:KIM, GRACE (MA, QMHP-C, NCC)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MA, QMHP-C, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N WASHINGTON ST STE 322
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1534
Mailing Address - Country:US
Mailing Address - Phone:540-845-6940
Mailing Address - Fax:
Practice Address - Street 1:2200 OPITZ BLVD STE 340
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3339
Practice Address - Country:US
Practice Address - Phone:540-845-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor