Provider Demographics
NPI:1558903591
Name:KING-CUTLER, MARIE (LCAS)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:KING-CUTLER
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-0395
Mailing Address - Country:US
Mailing Address - Phone:919-904-9720
Mailing Address - Fax:
Practice Address - Street 1:479 DOVE RD
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-9091
Practice Address - Country:US
Practice Address - Phone:919-904-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25323101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)