Provider Demographics
NPI:1508318049
Name:KING, CONNIE J (LMHC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:J
Last Name:KING
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 PLANTATION LAKES DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3013
Mailing Address - Country:US
Mailing Address - Phone:352-512-3475
Mailing Address - Fax:
Practice Address - Street 1:314 NW BETHANY DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3578
Practice Address - Country:US
Practice Address - Phone:772-284-6030
Practice Address - Fax:772-252-5746
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health