Healthcare Provider Details

I. General information

NPI: 1790251320
Provider Name (Legal Business Name): ALLISON ROGERS KING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9849 HIGHWAY 178
OLIVE BRANCH MS
38654-3214
US

IV. Provider business mailing address

9849 HIGHWAY 178
OLIVE BRANCH MS
38654-3214
US

V. Phone/Fax

Practice location:
  • Phone: 662-967-4642
  • Fax:
Mailing address:
  • Phone: 662-967-4642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC10177
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: