Provider Demographics
NPI:1730662727
Name:KING, KYEDA L (LCSW)
Entity Type:Individual
Prefix:
First Name:KYEDA
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 LITTLE HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3553
Mailing Address - Country:US
Mailing Address - Phone:678-480-2048
Mailing Address - Fax:
Practice Address - Street 1:1405 LITTLE HAMPTON DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3553
Practice Address - Country:US
Practice Address - Phone:678-480-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical