Provider Demographics
NPI:1326569351
Name:KING, KRISTEN JOY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:JOY
Last Name:KING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:JOY
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1223 WELLESLEY RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18223 E 10 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5821
Practice Address - Country:US
Practice Address - Phone:586-778-5880
Practice Address - Fax:586-778-4362
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680104441041C0700X
MI68010904441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical