Active NPI
Rebecca A.S. Kim, LPC
- Professional Counselor
- Athens, GA
National Provider Identifier
1417691023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 012929
- Practice address
- 105 Whitehead Rd # B6
Athens, GA 30606-1554 - Phone
- (706) 363-0432
- NPI assigned
- Apr 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 012929 | GA | Primary |
Addresses
Primary practice location
105 Whitehead Rd # B6
Athens, GA 30606-1554
Mailing address
PO Box 93
Jefferson, GA 30549-0093
Phone (706) 363-0432
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 11, 2024 through Apr 11, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012929 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696982400000",
"number": "1417691023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 93",
"city": "JEFFERSON",
"state": "GA",
"postal_code": "305490093",
"telephone_number": "706-363-0432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 WHITEHEAD RD # B6",
"city": "ATHENS",
"state": "GA",
"postal_code": "306061554",
"telephone_number": "706-363-0432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "REBECCA",
"middle_name": "A.S.",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-21",
"last_updated": "2023-10-11",
"certification_date": "2023-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "012929",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.