Provider Demographics
NPI:1164673034
Name:KING, CAROLYN J (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:J
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275B W PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-4719
Mailing Address - Country:US
Mailing Address - Phone:410-620-7161
Mailing Address - Fax:410-620-7168
Practice Address - Street 1:200 BOOTH ST.
Practice Address - Street 2:UPPER BAY COUNSELING
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:410-996-5104
Practice Address - Fax:410-996-5725
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00004291041C0700X
MD098901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD922801200Medicaid