Provider Demographics
NPI:1144418898
Name:KING, YOLANDA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:YOLANDA
Other - Middle Name:
Other - Last Name:TOLBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28351 GRATIOT AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4252
Mailing Address - Country:US
Mailing Address - Phone:313-978-1854
Mailing Address - Fax:
Practice Address - Street 1:28351 GRATIOT AVE STE 3
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4252
Practice Address - Country:US
Practice Address - Phone:586-350-0400
Practice Address - Fax:586-350-0401
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68010866921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker