Provider Demographics
NPI:1487109682
Name:KIM, ANNA RACHEL (LGSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:RACHEL
Last Name:KIM
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SCOTT AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8847
Mailing Address - Country:US
Mailing Address - Phone:304-292-1716
Mailing Address - Fax:
Practice Address - Street 1:165 SCOTT AVE STE 208
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-8847
Practice Address - Country:US
Practice Address - Phone:304-292-1716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00944721104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker