Provider Demographics
NPI:1881762094
Name:KING, CAROL M (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:KING
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Gender:F
Credentials:PHD
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Mailing Address - Street 1:5850 FARINGDON PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3930
Mailing Address - Country:US
Mailing Address - Phone:919-872-9974
Mailing Address - Fax:919-872-9975
Practice Address - Street 1:5850 FARINGDON PL
Practice Address - Street 2:SUITE 1
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3930
Practice Address - Country:US
Practice Address - Phone:919-872-9974
Practice Address - Fax:919-872-9975
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC1259103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000725Medicaid