Active NPI
Patricia Kim, PH.D.
- Clinical Psychologist
- Fairfax, VA
National Provider Identifier
1740651280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810006266
- Practice address
- 9480 Main St Ste 1160
Fairfax, VA 22031-4032 - Phone
- (571) 306-2006
- NPI assigned
- Oct 9, 2015
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810006266 | VA | Primary |
Addresses
Primary practice location
9480 Main St Ste 1160
Fairfax, VA 22031-4032
Mailing address
348 Northwood Way
#1
Palisades Park, NJ 07650-1952
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810006266 | VA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairfax Counseling Services, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Fairfax, VA
- NPI 1497044150
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744070400000",
"number": "1740651280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "348 NORTHWOOD WAY",
"address_2": "#1",
"city": "PALISADES PARK",
"state": "NJ",
"postal_code": "076501952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9480 MAIN ST STE 1160",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220314032",
"telephone_number": "571-306-2006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "PATRICIA",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-09",
"last_updated": "2025-04-08",
"certification_date": "2025-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810006266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.