Provider Demographics
NPI:1679189872
Name:KING, NICOLE MELISSA
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MELISSA
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ARIZONA AVE NE UNIT 408
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2257
Mailing Address - Country:US
Mailing Address - Phone:678-977-2680
Mailing Address - Fax:
Practice Address - Street 1:130 ARIZONA AVE NE UNIT 408
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2257
Practice Address - Country:US
Practice Address - Phone:678-977-2680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical