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NPI Code Detail

MEDICARE: MICHELLE NICOLE KING LCSW, CADCIII

MEDICARE: MICHELLE NICOLE KING LCSW, CADCIII
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
1101YA0400XAddiction (Substance Use Disorder) Counselor19-08-05OR
2175T00000XPeer Specialist19-CRM-II-006OR
31041C0700XClinical Social WorkerL15955OR
4175T00000XPeer Specialist15-CRM-105OR
5101YM0800XMental Health Counselor20-QMHP-R-0145OR

General Provider Information

NPI Number : 1952760670
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE NICOLE KING LCSW, CADCIII
Provider Business Mailing Address
First Line : 500 NE MULTNOMAH ST STE 100
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2099
Country : US
Telephone Number : 800-813-2000
Fax Number :
Provider Business Practice Location Address
First Line : 3550 N INTERSTATE AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1196
Country : US
Telephone Number : 503-457-4772
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2016
Last Update Date : 03/12/2026

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