Healthcare Provider Details

I. General information

NPI: 1124932918
Provider Name (Legal Business Name): CASSIE DAWN KING LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ZEBULON CT
ROCKY MOUNT NC
27804-2420
US

IV. Provider business mailing address

118 BROWNLEA DR APT 7
GREENVILLE NC
27858-1647
US

V. Phone/Fax

Practice location:
  • Phone: 252-972-4357
  • Fax: 252-972-1911
Mailing address:
  • Phone: 919-495-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number31857
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: