Provider Demographics
NPI:1659750321
Name:KING, ERIC LANGDON (LICSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LANGDON
Last Name:KING
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19815 BAY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-9234
Mailing Address - Country:US
Mailing Address - Phone:334-222-2523
Mailing Address - Fax:
Practice Address - Street 1:587 BENTLEY AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-1808
Practice Address - Country:US
Practice Address - Phone:334-335-5201
Practice Address - Fax:334-335-5206
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4397C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical