Provider Demographics
NPI:1255797965
Name:KING, CHARLES (PHD LAC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:PHD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3746 GOVERNMENT ST STE 8
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-3252
Mailing Address - Country:US
Mailing Address - Phone:318-787-6612
Mailing Address - Fax:318-787-6612
Practice Address - Street 1:3746 GOVERNMENT ST STE 8
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-3252
Practice Address - Country:US
Practice Address - Phone:318-787-6612
Practice Address - Fax:318-787-6612
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1029101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)