Healthcare Provider Details

I. General information

NPI: 1376169466
Provider Name (Legal Business Name): MAGGIE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W HOWZE BEACH RD
SLIDELL LA
70458-8501
US

IV. Provider business mailing address

132 W HOWZE BEACH RD
SLIDELL LA
70458-8501
US

V. Phone/Fax

Practice location:
  • Phone: 985-445-1800
  • Fax: 985-445-1802
Mailing address:
  • Phone: 985-445-1800
  • Fax: 985-445-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18442
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: