Provider Demographics
NPI:1467764852
Name:KING, KATHY JO (LGPC;LCPMH)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:JO
Last Name:KING
Suffix:
Gender:F
Credentials:LGPC;LCPMH
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:JO
Other - Last Name:STADLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC;LPCMH
Mailing Address - Street 1:20791 BRUNSWICK LN
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-7552
Mailing Address - Country:US
Mailing Address - Phone:302-663-0274
Mailing Address - Fax:
Practice Address - Street 1:17527 NASSAU COMMONS BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6283
Practice Address - Country:US
Practice Address - Phone:302-663-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELPC0000664101YP2500X
MDLC3900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional