Provider Demographics
NPI:1538482120
Name:KING, GINGER FAYE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:GINGER
Middle Name:FAYE
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3873 N 74TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1903
Mailing Address - Country:US
Mailing Address - Phone:414-975-4094
Mailing Address - Fax:414-921-4143
Practice Address - Street 1:3873 N 74TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1903
Practice Address - Country:US
Practice Address - Phone:414-975-4094
Practice Address - Fax:414-921-4143
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75301231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43705500Medicaid