Provider Demographics
NPI:1083249106
Name:KING, CHIQUITA MARIA (MSW, LCSWA)
Entity Type:Individual
Prefix:MS
First Name:CHIQUITA
Middle Name:MARIA
Last Name:KING
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 BLUE HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4944
Mailing Address - Country:US
Mailing Address - Phone:704-780-8539
Mailing Address - Fax:
Practice Address - Street 1:330 S YORK ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4052
Practice Address - Country:US
Practice Address - Phone:704-780-8539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0143261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000023572617Medicaid