Provider Demographics
NPI:1740781020
Name:KING, SYDNEY TAYLOR
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:TAYLOR
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 1:432 E RICH ST UNIT 2K
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5388
Mailing Address - Country:US
Mailing Address - Phone:601-525-6414
Mailing Address - Fax:
Practice Address - Street 1:2238 S HAMILTON RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232
Practice Address - Country:US
Practice Address - Phone:614-751-0042
Practice Address - Fax:614-751-0047
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health