Healthcare Provider Details

I. General information

NPI: 1417746900
Provider Name (Legal Business Name): KING EDWARDS' INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 LA SALLE RD CHESTER BLDG SUITE302
TOWSON MD
21286-2001
US

IV. Provider business mailing address

8600 LA SALLE RD CHESTER BLDG SUITE302
TOWSON MD
21286-2001
US

V. Phone/Fax

Practice location:
  • Phone: 410-494-9212
  • Fax: 410-494-9212
Mailing address:
  • Phone: 410-494-9212
  • Fax: 410-494-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATRINA SHIRD CLAYTON
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW-C
Phone: 410-494-9212