Provider Demographics
NPI:1013036649
Name:KING, PERRY VAUGHN (LICSW)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:VAUGHN
Last Name:KING
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 14TH ST NW
Mailing Address - Street 2:SUITE 402B
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6865
Mailing Address - Country:US
Mailing Address - Phone:202-745-4300
Mailing Address - Fax:202-232-0723
Practice Address - Street 1:3020 14TH ST NW
Practice Address - Street 2:SUITE 402B
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6865
Practice Address - Country:US
Practice Address - Phone:202-745-4300
Practice Address - Fax:202-232-0723
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3022421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical