Provider Demographics
NPI:1780259655
Name:KING, CAROLETTE YVONNE
Entity type:Individual
Prefix:
First Name:CAROLETTE
Middle Name:YVONNE
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAROLETTE
Other - Middle Name:YVONNE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6185 MAGNOLIA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2524
Mailing Address - Country:US
Mailing Address - Phone:951-370-1470
Mailing Address - Fax:800-319-9384
Practice Address - Street 1:15740 TURNBERRY ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4903
Practice Address - Country:US
Practice Address - Phone:951-370-1470
Practice Address - Fax:800-319-9384
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW994681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical