Healthcare Provider Details

I. General information

NPI: 1720824048
Provider Name (Legal Business Name): ANGELA RAE KING LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENTON DR STE 200
CHARLESTON WV
25311-1256
US

IV. Provider business mailing address

1005 WHITE WILLOW WAY
MORGANTOWN WV
26505-6119
US

V. Phone/Fax

Practice location:
  • Phone: 304-513-3495
  • Fax: 800-734-8498
Mailing address:
  • Phone: 304-460-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3226
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: