Provider Demographics
NPI:1770652133
Name:KING, CAROL (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:KING
Other - Last Name:BUNNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 450091
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-0091
Mailing Address - Country:US
Mailing Address - Phone:972-234-2333
Mailing Address - Fax:972-234-8964
Practice Address - Street 1:1221 ABRAMS RD STE 232
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5581
Practice Address - Country:US
Practice Address - Phone:972-234-2333
Practice Address - Fax:972-234-8964
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSO40531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86311QOtherBCBS
TX127930OtherVALUE OPTIONS
TX86311QOtherBCBS