Provider Demographics
NPI:1376124818
Name:KING, LACEE MAREE (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:LACEE
Middle Name:MAREE
Last Name:KING
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:LACEE
Other - Middle Name:MAREE
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:1701 OLMSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-3343
Mailing Address - Country:US
Mailing Address - Phone:269-903-0550
Mailing Address - Fax:269-903-0536
Practice Address - Street 1:1701 OLMSTEAD RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-3343
Practice Address - Country:US
Practice Address - Phone:269-903-0550
Practice Address - Fax:269-903-0536
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical