Healthcare Provider Details

I. General information

NPI: 1679435358
Provider Name (Legal Business Name): LISA MAY KING LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WILSON RD
WILLIAMSVILLE NY
14221-7026
US

IV. Provider business mailing address

548 HIGHGATE AVE
BUFFALO NY
14215-1204
US

V. Phone/Fax

Practice location:
  • Phone: 716-529-3057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number130027
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: