Healthcare Provider Details

I. General information

NPI: 1053237818
Provider Name (Legal Business Name): FAYOLA KING LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10909 MOUNT LUBENTIA WAY
UPPER MARLBORO MD
20774-5724
US

IV. Provider business mailing address

10909 MOUNT LUBENTIA WAY
UPPER MARLBORO MD
20774-5724
US

V. Phone/Fax

Practice location:
  • Phone: 202-415-4589
  • Fax:
Mailing address:
  • Phone: 202-415-4589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC13920
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: