Provider Demographics
NPI:1366692063
Name:KING, DORIS ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:ELAINE
Last Name: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 1:111 S MERAMEC AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1711
Mailing Address - Country:US
Mailing Address - Phone:314-679-7833
Mailing Address - Fax:314-679-7846
Practice Address - Street 1:111 S MERAMEC AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1711
Practice Address - Country:US
Practice Address - Phone:314-679-7833
Practice Address - Fax:314-679-7846
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0012381041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493397103Medicaid
MO493397103Medicaid