Provider Demographics
NPI:1710599360
Name:KIM, JESSICA (LMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S MAIN ST # 1020
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4907
Mailing Address - Country:US
Mailing Address - Phone:401-484-0559
Mailing Address - Fax:
Practice Address - Street 1:300 S MAIN ST # 1020
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4907
Practice Address - Country:US
Practice Address - Phone:401-484-0559
Practice Address - Fax:401-240-1207
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health