Provider Demographics
NPI:1043645310
Name:KING, GERRY ANN (CRADC)
Entity Type:Individual
Prefix:
First Name:GERRY
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:CRADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 VANDIVER
Mailing Address - Street 2:SUITE Y
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202
Mailing Address - Country:US
Mailing Address - Phone:816-401-1310
Mailing Address - Fax:
Practice Address - Street 1:1301 VANDIVER DR
Practice Address - Street 2:SUITE Y
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3900
Practice Address - Country:US
Practice Address - Phone:816-401-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)