Provider Demographics
NPI:1013463116
Name:KING, LAKISHA (LCSWA)
Entity Type:Individual
Prefix:MS
First Name:LAKISHA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 WAYNE MEMORIAL DR
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2255
Mailing Address - Country:US
Mailing Address - Phone:919-734-0753
Mailing Address - Fax:
Practice Address - Street 1:1318 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE A & B
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2255
Practice Address - Country:US
Practice Address - Phone:919-734-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0105111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical