Provider Demographics
NPI:1093377558
Name:KING, SAGAN MARIE (PSYD, LP, HSPP)
Entity Type:Individual
Prefix:
First Name:SAGAN
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:PSYD, LP, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 E NC HIGHWAY 54 APT U
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2672
Mailing Address - Country:US
Mailing Address - Phone:419-771-0307
Mailing Address - Fax:
Practice Address - Street 1:1447 E NC HIGHWAY 54 APT U
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2672
Practice Address - Country:US
Practice Address - Phone:419-771-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6491103TC0700X
VA0701008243101YP2500X
IN39003210A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health