Provider Demographics
NPI:1669690277
Name:KING'S LEARNING CENTER
Entity type:Organization
Organization Name:KING'S LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-738-7474
Mailing Address - Street 1:3711 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-8840
Mailing Address - Country:US
Mailing Address - Phone:910-738-7474
Mailing Address - Fax:
Practice Address - Street 1:3711 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-8840
Practice Address - Country:US
Practice Address - Phone:910-738-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78000070235Z00000X, 251300000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered251300000XAgenciesLocal Education Agency (LEA)
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC78000070OtherDHHS STATE LICENSE
NC8300179Medicaid
NC7211882Medicare ID - Type UnspecifiedSPEECH