Provider Demographics
NPI:1093964389
Name:KING, ELIZABETH ANN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:KING-CANTOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 870078
Mailing Address - Street 2:
Mailing Address - City:MILTON VILLAGE
Mailing Address - State:MA
Mailing Address - Zip Code:02187-0078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7042
Practice Address - Country:US
Practice Address - Phone:978-400-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor