Provider Demographics
NPI:1043747975
Name:KING, NATASHA R (LCSW)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 BRIARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39563-2310
Mailing Address - Country:US
Mailing Address - Phone:228-342-7447
Mailing Address - Fax:228-475-2809
Practice Address - Street 1:4770 AMOCO DR
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-9627
Practice Address - Country:US
Practice Address - Phone:228-474-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC84181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical