Provider Demographics
NPI:1164879854
Name:KING, TARA SANDREA (MSW,LCSW LCAS,CCSOTS)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:SANDREA
Last Name:KING
Suffix:
Gender:F
Credentials:MSW,LCSW LCAS,CCSOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 FARMINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8786
Mailing Address - Country:US
Mailing Address - Phone:252-531-6226
Mailing Address - Fax:
Practice Address - Street 1:418 FARMINGWOOD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-8786
Practice Address - Country:US
Practice Address - Phone:252-531-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3168101YA0400X
NCCO137631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)