Provider Demographics
NPI:1720371305
Name:KING, MYRA E (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 EAST WEST HIGHWAY
Mailing Address - Street 2:SUITE OH-GROUND LEVEL
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:301-565-0142
Mailing Address - Fax:301-565-0142
Practice Address - Street 1:1400 EAST WEST HIGHWAY
Practice Address - Street 2:SUITE OH-GROUND LEVEL
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910
Practice Address - Country:US
Practice Address - Phone:301-565-0142
Practice Address - Fax:301-565-0142
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD021041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical