Provider Demographics
NPI:1326436908
Name:KING, DALE E (LMSW)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DALE
Other - Middle Name:E
Other - Last Name:DUROVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 E. GUADALUPE ROAD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283
Mailing Address - Country:US
Mailing Address - Phone:480-921-3314
Mailing Address - Fax:480-967-0174
Practice Address - Street 1:1405 E. GUADALUPE ROAD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283
Practice Address - Country:US
Practice Address - Phone:480-921-3314
Practice Address - Fax:480-967-0174
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-13472104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ816074Medicaid