Provider Demographics
NPI:1841435435
Name:KING, MICKIE CALAME (LCSW LCDC)
Entity type:Individual
Prefix:MS
First Name:MICKIE
Middle Name:CALAME
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SCENIC TER
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-9635
Mailing Address - Country:US
Mailing Address - Phone:512-255-3966
Mailing Address - Fax:
Practice Address - Street 1:9 SCENIC TER
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-9635
Practice Address - Country:US
Practice Address - Phone:512-255-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1280101YA0400X
TX062051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)