Healthcare Provider Details

I. General information

NPI: 1871411868
Provider Name (Legal Business Name): YVONNE M KING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4520 FIRESTONE ST
DEARBORN MI
48126-4602
US

IV. Provider business mailing address

8771 LEROY ST
OAK PARK MI
48237-2304
US

V. Phone/Fax

Practice location:
  • Phone: 313-470-1860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401020167
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: