Provider Demographics
NPI:1255926663
Name:KIM, GIORGIANA ANGELICA (LLMSW)
Entity type:Individual
Prefix:
First Name:GIORGIANA
Middle Name:ANGELICA
Last Name:KIM
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLSMW
Mailing Address - Street 1:1780 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4998
Mailing Address - Country:US
Mailing Address - Phone:517-273-1484
Mailing Address - Fax:
Practice Address - Street 1:1780 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4998
Practice Address - Country:US
Practice Address - Phone:517-273-1484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011023121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical