Provider Demographics
NPI:1154636009
Name:KING, STEPHEN E
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:E
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:APPOMATTOX
Mailing Address - State:VA
Mailing Address - Zip Code:24522-0099
Mailing Address - Country:US
Mailing Address - Phone:434-352-9877
Mailing Address - Fax:434-352-4321
Practice Address - Street 1:11866 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:APPOMATTOX
Practice Address - State:VA
Practice Address - Zip Code:24522-7995
Practice Address - Country:US
Practice Address - Phone:434-352-9877
Practice Address - Fax:434-352-4321
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102911010Medicaid
VA0102911432Medicaid