Healthcare Provider Details

I. General information

NPI: 1225133564
Provider Name (Legal Business Name): CAROL M KING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 SOUTH ST
MANASQUAN NJ
08736-3440
US

IV. Provider business mailing address

311 11TH AVE
SPRING LAKE NJ
07762-1946
US

V. Phone/Fax

Practice location:
  • Phone: 732-413-3884
  • Fax:
Mailing address:
  • Phone: 301-564-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00443500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: