Provider Demographics
NPI:1649731118
Name:KING, ALDREQUES ANDROS (PASTORAL COUNSELOR)
Entity type:Individual
Prefix:
First Name:ALDREQUES
Middle Name:ANDROS
Last Name:KING
Suffix:
Gender:M
Credentials:PASTORAL COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 STILESBORO RD NW STE 225
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7748
Mailing Address - Country:US
Mailing Address - Phone:800-910-5060
Mailing Address - Fax:800-634-6360
Practice Address - Street 1:5205 STILESBORO RD NW STE 225
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7748
Practice Address - Country:US
Practice Address - Phone:800-910-5060
Practice Address - Fax:800-634-6360
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA07175319101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral