Provider Demographics
NPI:1477813814
Name:KING, DORIS MAE (MA)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:MAE
Last Name:KING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:DORIS
Other - Middle Name:MAE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-0385
Mailing Address - Country:US
Mailing Address - Phone:304-881-2975
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 357
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-9733
Practice Address - Country:US
Practice Address - Phone:304-881-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1879101YP2500X
WVAP00940294104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker