Provider Demographics
NPI:1073877429
Name:KING, KIEVONNE DENISE (LCSW)
Entity Type:Individual
Prefix:
First Name:KIEVONNE
Middle Name:DENISE
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 1:7421 CARMEL EXECUTIVE PARK DR STE 226
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-0414
Mailing Address - Country:US
Mailing Address - Phone:704-270-5066
Mailing Address - Fax:980-422-0166
Practice Address - Street 1:7421 CARMEL EXECUTIVE PARK DR STE 226
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-270-5066
Practice Address - Fax:980-422-0166
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-30
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW121281041C0700X
NCC0114421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical