Provider Demographics
NPI:1093088346
Name:KING, DEIRDRE MICHELLE (MSW, P-LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:MICHELLE
Last Name:KING
Suffix:
Gender:F
Credentials:MSW, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5236 HILLTOP RD UNIT 306
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9825
Mailing Address - Country:US
Mailing Address - Phone:336-681-0297
Mailing Address - Fax:336-334-7197
Practice Address - Street 1:2211 W MEADOWVIEW RD
Practice Address - Street 2:SUITE 114
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407
Practice Address - Country:US
Practice Address - Phone:336-855-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0069811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical