Provider Demographics
NPI:1669793782
Name:SHIM, YOUNG RAE (PH D)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:RAE
Last Name:SHIM
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 LANGFORD RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4772
Mailing Address - Country:US
Mailing Address - Phone:216-272-1986
Mailing Address - Fax:
Practice Address - Street 1:3000 LANGFORD RD
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30071-1521
Practice Address - Country:US
Practice Address - Phone:216-272-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6438103T00000X
GALPC009531101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty