Provider Demographics
NPI:1841178092
Name:KIM, ELAINE (LMSW)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:KIM
Suffix:
Gender:X
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16814 CENTERFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2031
Mailing Address - Country:US
Mailing Address - Phone:202-603-2117
Mailing Address - Fax:
Practice Address - Street 1:16814 CENTERFIELD WAY
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2031
Practice Address - Country:US
Practice Address - Phone:202-603-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18366101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health