Healthcare Provider Details

I. General information

NPI: 1558903591
Provider Name (Legal Business Name): MARIE KING-CUTLER LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

479 DOVE RD
CAMERON NC
28326-9091
US

IV. Provider business mailing address

PO BOX 395
CAMERON NC
28326-0395
US

V. Phone/Fax

Practice location:
  • Phone: 919-904-9720
  • Fax:
Mailing address:
  • Phone: 919-904-9720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-25323
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: