Provider Demographics
NPI:1912147463
Name:KING, BETTY RUTH (MS)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:RUTH
Last Name:KING
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:RUTH
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSMS,LPC
Mailing Address - Street 1:809 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-7843
Mailing Address - Country:US
Mailing Address - Phone:334-480-9806
Mailing Address - Fax:706-653-4020
Practice Address - Street 1:3100 GENTIAN BLVD
Practice Address - Street 2:SUITE 14B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5636
Practice Address - Country:US
Practice Address - Phone:706-718-3352
Practice Address - Fax:706-653-4020
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005146101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional