Provider Demographics
NPI:1851609523
Name:YVONNE YIM LICENSED CLINICAL SOCIAL WORKER AND CONSULTANT LLC
Entity Type:Organization
Organization Name:YVONNE YIM LICENSED CLINICAL SOCIAL WORKER AND CONSULTANT LLC
Other - Org Name:YVONNE YIM LICENSED CLINICAL SOCIAL WORKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:BD
Authorized Official - Last Name:YIM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-469-2161
Mailing Address - Street 1:1920 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1920 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2129
Practice Address - Country:US
Practice Address - Phone:808-469-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3015310400000X, 313M00000X, 314000000X, 3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric