Provider Demographics
NPI:1013303775
Name:KING, CHRISTIAN LAMAR (LPC)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:LAMAR
Last Name:KING
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2243
Mailing Address - Country:US
Mailing Address - Phone:865-386-4591
Mailing Address - Fax:
Practice Address - Street 1:11111 HOUZE RD STE 225
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5618
Practice Address - Country:US
Practice Address - Phone:770-603-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GALPC015267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health