Provider Demographics
NPI:1972658912
Name:ST. KING, JUDITH ANN (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:ST. 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 1:4660 MARSH ROAD
Mailing Address - Street 2:B - 2
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2037
Mailing Address - Country:US
Mailing Address - Phone:517-930-2018
Mailing Address - Fax:517-347-7892
Practice Address - Street 1:4660 MARSH ROAD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2037
Practice Address - Country:US
Practice Address - Phone:517-930-2018
Practice Address - Fax:517-347-7892
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010627771041C0700X
CALCS 246661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical