Provider Demographics
NPI:1124308143
Name:KANG, JINHEE (PHD, LP)
Entity type:Individual
Prefix:
First Name:JINHEE
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 AQUAMARINE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5362
Mailing Address - Country:US
Mailing Address - Phone:804-338-2001
Mailing Address - Fax:
Practice Address - Street 1:2024 AQUAMARINE TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5362
Practice Address - Country:US
Practice Address - Phone:804-338-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003098103TC0700X
MD05080103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical