Provider Demographics
NPI:1326073156
Name:CALLAHAN-KING, KAITLYN ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:ELIZABETH
Last Name:CALLAHAN-KING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-1023
Mailing Address - Country:US
Mailing Address - Phone:828-766-7756
Mailing Address - Fax:828-766-5599
Practice Address - Street 1:205 LOCUST AVE
Practice Address - Street 2:SUITED
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-2713
Practice Address - Country:US
Practice Address - Phone:828-766-7756
Practice Address - Fax:828-766-5599
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0029821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002548Medicaid
NC13282OtherBLUE CROSS & BLUE SHIELD
NC13282OtherBLUE CROSS & BLUE SHIELD