Healthcare Provider Details

I. General information

NPI: 1992432256
Provider Name (Legal Business Name): CORA ANN WILLIS-KING MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 41
MIDDLESBORO KY
40965-0041
US

IV. Provider business mailing address

PO BOX 41
MIDDLESBORO KY
40965-0041
US

V. Phone/Fax

Practice location:
  • Phone: 606-518-0701
  • Fax:
Mailing address:
  • Phone: 606-528-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number290083
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: