Provider Demographics
NPI:1336279553
Name:KING, ROBERT LEE (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:KING
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S FUQUAY AVE
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2254
Mailing Address - Country:US
Mailing Address - Phone:919-552-9550
Mailing Address - Fax:919-552-3405
Practice Address - Street 1:209 S FUQUAY AVE
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2254
Practice Address - Country:US
Practice Address - Phone:919-552-9550
Practice Address - Fax:919-552-3405
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9483101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003223Medicaid