Provider Demographics
NPI:1093063018
Name:KING, M COLLEEN (LCSW CADC)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:COLLEEN
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 S NAPERVILLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5846
Mailing Address - Country:US
Mailing Address - Phone:630-260-0606
Mailing Address - Fax:630-260-1049
Practice Address - Street 1:1761 S NAPERVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5846
Practice Address - Country:US
Practice Address - Phone:630-260-0606
Practice Address - Fax:630-260-1049
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0145031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical