Provider Demographics
NPI:1790484525
Name:KING, MIKI LEA
Entity Type:Individual
Prefix:
First Name:MIKI
Middle Name:LEA
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 1:249 SKIDMORE LN
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-9272
Mailing Address - Country:US
Mailing Address - Phone:304-561-5319
Mailing Address - Fax:
Practice Address - Street 1:249 SKIDMORE LN
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-9272
Practice Address - Country:US
Practice Address - Phone:304-561-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor