Provider Demographics
NPI:1154932226
Name:KROM, DAVID (LMHCA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KROM
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:VICTOR
Other - Last Name:KROM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2319 N 45TH ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6978
Mailing Address - Country:US
Mailing Address - Phone:206-627-7861
Mailing Address - Fax:
Practice Address - Street 1:2319 N 45TH ST STE 209
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6978
Practice Address - Country:US
Practice Address - Phone:206-627-7861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61432566101YM0800X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist