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NPI Code Detail

MEDICARE: STACIA ROSE KING MSW

MEDICARE: STACIA ROSE KING MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker222776MA
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1023501459
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACIA ROSE KING MSW
Provider Business Mailing Address
First Line : 1030 FAYETTEVILLE RD SE
Second Line :
City : ATLANTA
State : GA
Zip : 30316-2921
Country : US
Telephone Number : 404-828-0871
Fax Number :
Provider Business Practice Location Address
First Line : 1030 FAYETTEVILLE RD SE
Second Line :
City : ATLANTA
State : GA
Zip : 30316-2921
Country : US
Telephone Number : 404-828-0871
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2018
Last Update Date : 08/18/2020

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