Provider Demographics
NPI:1376051300
Name:KING, RAHNETTA SOPHIA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:RAHNETTA
Middle Name:SOPHIA
Last Name:KING
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:RAHNETTA
Other - Middle Name:SOPHIA
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 66171
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-6171
Mailing Address - Country:US
Mailing Address - Phone:248-991-4300
Mailing Address - Fax:
Practice Address - Street 1:2995 E GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3133
Practice Address - Country:US
Practice Address - Phone:313-758-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional