Provider Demographics
NPI:1497825640
Name:KING, PRISCILLA JOANNE (LPC)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:JOANNE
Last Name:KING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 FOXBORO LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1633
Mailing Address - Country:US
Mailing Address - Phone:678-523-0525
Mailing Address - Fax:770-451-5414
Practice Address - Street 1:4485 TENCH RD
Practice Address - Street 2:SUITE 850
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6739
Practice Address - Country:US
Practice Address - Phone:678-523-0525
Practice Address - Fax:770-451-5414
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional