Provider Demographics
NPI:1013790682
Name:KING, KERRIE ANN (LGPC LPC10206)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:LGPC LPC10206
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 REGENCY PL STE 203
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3088
Mailing Address - Country:US
Mailing Address - Phone:240-427-3554
Mailing Address - Fax:240-419-2556
Practice Address - Street 1:QCI BEHAVIORAL HEALTH
Practice Address - Street 2:5010 REGENCY PLACE, SUITE 203
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695
Practice Address - Country:US
Practice Address - Phone:240-427-3554
Practice Address - Fax:240-419-2556
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLPC10206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional