Healthcare Provider Details

I. General information

NPI: 1043747975
Provider Name (Legal Business Name): NATASHA R KING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 AMOCO DR
MOSS POINT MS
39563-9627
US

IV. Provider business mailing address

2714 BRIARWOOD CIR
MOSS POINT MS
39563-2310
US

V. Phone/Fax

Practice location:
  • Phone: 228-474-9511
  • Fax:
Mailing address:
  • Phone: 228-342-7447
  • Fax: 228-475-2809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC8418
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: