Provider Demographics
NPI:1578091252
Name:MICHAEL KING LCSW LLC
Entity Type:Organization
Organization Name:MICHAEL KING LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ESTEL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:706-669-3526
Mailing Address - Street 1:201 COVE RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1356
Mailing Address - Country:US
Mailing Address - Phone:706-253-9515
Mailing Address - Fax:706-253-9516
Practice Address - Street 1:201 COVE RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1356
Practice Address - Country:US
Practice Address - Phone:706-253-9515
Practice Address - Fax:706-253-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0060941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty