Provider Demographics
NPI:1407569775
Name:KING, CHARLOTTE LESLIE (CAADAC II)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LESLIE
Last Name:KING
Suffix:
Gender:F
Credentials:CAADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 LAKEPOINTE DR STE 117
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6425
Mailing Address - Country:US
Mailing Address - Phone:214-379-3300
Mailing Address - Fax:
Practice Address - Street 1:13700 58TH ST. N, BLDG 2, SUITE 209
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760
Practice Address - Country:US
Practice Address - Phone:727-223-3545
Practice Address - Fax:727-223-3785
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0018590515101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty