Provider Demographics
NPI:1609054741
Name:KIM, HANK W (LCADC)
Entity Type:Individual
Prefix:MR
First Name:HANK
Middle Name:W
Last Name:KIM
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ARCADIA CT
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1601
Mailing Address - Country:US
Mailing Address - Phone:201-394-4055
Mailing Address - Fax:973-357-0519
Practice Address - Street 1:280 BROAD AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1574
Practice Address - Country:US
Practice Address - Phone:201-394-4055
Practice Address - Fax:973-357-0519
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00122900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)