Healthcare Provider Details

I. General information

NPI: 1093377558
Provider Name (Legal Business Name): SAGAN MARIE KING PSY.D., LP, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2019
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 E NC HIGHWAY 54 APT U
DURHAM NC
27713-2672
US

IV. Provider business mailing address

1447 E NC HIGHWAY 54 APT U
DURHAM NC
27713-2672
US

V. Phone/Fax

Practice location:
  • Phone: 419-771-0307
  • Fax:
Mailing address:
  • Phone: 419-771-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6491
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008243
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003210A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: