Healthcare Provider Details

I. General information

NPI: 1154244036
Provider Name (Legal Business Name): CYNTHIA JOY KING LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W 4TH ST STE 2
WILMINGTON DE
19805-3352
US

IV. Provider business mailing address

2500 W 4TH ST STE 2
WILMINGTON DE
19805-3352
US

V. Phone/Fax

Practice location:
  • Phone: 404-202-2061
  • Fax:
Mailing address:
  • Phone: 404-202-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00818900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: