Provider Demographics
NPI:1225019722
Name:KING, NANCY LEIGH (LCSW, LCAS)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEIGH
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E BESSEMER AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6324
Mailing Address - Country:US
Mailing Address - Phone:336-379-7144
Mailing Address - Fax:336-379-7145
Practice Address - Street 1:213 E BESSEMER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6324
Practice Address - Country:US
Practice Address - Phone:336-379-7144
Practice Address - Fax:336-379-7145
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0002741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002257Medicaid
NC6002257Medicaid