Provider Demographics
NPI:1992451454
Name:KIM, NICHOLE DASOM
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:DASOM
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 E CASCALOTE DR
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-3862
Mailing Address - Country:US
Mailing Address - Phone:610-757-7026
Mailing Address - Fax:
Practice Address - Street 1:4221 E CASCALOTE DR
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-3862
Practice Address - Country:US
Practice Address - Phone:610-757-7026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health