Provider Demographics
NPI:1356814446
Name:KING CLARKE CONSULTATION PARTNERS, LLC
Entity Type:Organization
Organization Name:KING CLARKE CONSULTATION PARTNERS, LLC
Other - Org Name:THRIVEWORKS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:267-546-7511
Mailing Address - Street 1:1501 S 17TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:519 DAVISVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1525
Practice Address - Country:US
Practice Address - Phone:267-546-7511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty