Provider Demographics
NPI:1790847564
Name:KING, MICHELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5016
Mailing Address - Country:US
Mailing Address - Phone:334-821-1822
Mailing Address - Fax:334-821-1822
Practice Address - Street 1:703 E GLENN AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5016
Practice Address - Country:US
Practice Address - Phone:334-821-1822
Practice Address - Fax:334-821-1822
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL750103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR63070Medicare UPIN