Provider Demographics
NPI:1982634408
Name:KING, ALICE MAE (SWS)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:MAE
Last Name:KING
Suffix:
Gender:F
Credentials:SWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 FINANCIAL PLZ
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-2615
Mailing Address - Country:US
Mailing Address - Phone:318-632-2040
Mailing Address - Fax:318-632-2040
Practice Address - Street 1:6005 FINANCIAL PLZ
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2615
Practice Address - Country:US
Practice Address - Phone:318-632-2040
Practice Address - Fax:318-632-2040
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical