Provider Demographics
NPI:1265000236
Name:KING-MARKS, REBECCA (LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:KING-MARKS
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 BERWICK VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-3297
Mailing Address - Country:US
Mailing Address - Phone:516-589-4179
Mailing Address - Fax:
Practice Address - Street 1:130 IOWA LN STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-2401
Practice Address - Country:US
Practice Address - Phone:516-589-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0160671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical