Provider Demographics
NPI:1164921565
Name:KING, MARIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1156
Mailing Address - Country:US
Mailing Address - Phone:502-216-8505
Mailing Address - Fax:
Practice Address - Street 1:440 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1156
Practice Address - Country:US
Practice Address - Phone:334-673-2143
Practice Address - Fax:334-673-2159
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional