NPI Number: 1043359193
Health Care Provider/Practitioner: LISA MARIE KING PSY.D., MSW, LP, CAP
Information about “1043359193” NPI (LISA MARIE KING PSY.D., MSW, LP, CAP)
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<Npi>
<NPI>
1043359193
</NPI>
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Individual
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N
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<ParentOrgTIN/>
<OrgName/>
<LastName>
KING
</LastName>
<FirstName>
LISA
</FirstName>
<MiddleName>
MARIE
</MiddleName>
<NamePrefix>
DR.
</NamePrefix>
<NameSuffix/>
<Credential>
PSY.D., MSW, LP, CAP
</Credential>
<OtherOrgName/>
<OtherOrgNameTypeCode/>
<OtherLastName>
FRIEMARK, NIEMAN, NELSON
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LISA
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1
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<FirstLineMailingAddress>
950 6TH AVE N
</FirstLineMailingAddress>
<SecondLineMailingAddress/>
<MailingAddressCityName>
NAPLES
</MailingAddressCityName>
<MailingAddressStateName>
FL
</MailingAddressStateName>
<MailingAddressPostalCode>
34102-5633
</MailingAddressPostalCode>
<MailingAddressCountryCode>
US
</MailingAddressCountryCode>
<MailingAddressTelephoneNumber>
239-659-2345
</MailingAddressTelephoneNumber>
<MailingAddressFaxNumber/>
<FirstLinePracticeLocationAddress>
950 6TH AVE N
</FirstLinePracticeLocationAddress>
<SecondLinePracticeLocationAddress/>
<PracticeLocationAddressCityName>
NAPLES
</PracticeLocationAddressCityName>
<PracticeLocationAddressStateName>
FL
</PracticeLocationAddressStateName>
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34102-5633
</PracticeLocationAddressPostalCode>
<PracticeLocationAddressCountryCode>
US
</PracticeLocationAddressCountryCode>
<PracticeLocationAddressTelephoneNumber>
239-659-2345
</PracticeLocationAddressTelephoneNumber>
<PracticeLocationAddressFaxNumber/>
<EnumerationDate>
02/05/2007
</EnumerationDate>
<LastUpdateDate>
11/09/2015
</LastUpdateDate>
<NPIDeactivationReasonCode/>
<NPIDeactivationReason/>
<NPIDeactivationDate/>
<NPIReactivationDate/>
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F
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<Gender>
Female
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<Taxonomy>
<TaxonomyCode>
101YA0400X
</TaxonomyCode>
<TaxonomyName>
Addiction (Substance Use Disorder) Counselor
</TaxonomyName>
<LicenseNumber>
6801078040
</LicenseNumber>
<LicenseNumberStateCode>
MI
</LicenseNumberStateCode>
<PrimaryTaxonomySwitch>
N
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</Taxonomy>
<Taxonomy>
<TaxonomyCode>
101YM0800X
</TaxonomyCode>
<TaxonomyName>
Mental Health Counselor
</TaxonomyName>
<LicenseNumber>
6801078040
</LicenseNumber>
<LicenseNumberStateCode>
MI
</LicenseNumberStateCode>
<PrimaryTaxonomySwitch>
N
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</Taxonomy>
<Taxonomy>
<TaxonomyCode>
1041C0700X
</TaxonomyCode>
<TaxonomyName>
Clinical Social Worker
</TaxonomyName>
<LicenseNumber>
6801078040
</LicenseNumber>
<LicenseNumberStateCode>
MI
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<PrimaryTaxonomySwitch>
N
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</Taxonomy>
<Taxonomy>
<TaxonomyCode>
103TC0700X
</TaxonomyCode>
<TaxonomyName>
Clinical Psychologist
</TaxonomyName>
<LicenseNumber>
PY9434
</LicenseNumber>
<LicenseNumberStateCode>
FL
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<PrimaryTaxonomySwitch>
Y
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<Taxonomy>
<TaxonomyCode>
103TA0400X
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<TaxonomyName>
Addiction (Substance Use Disorder) Psychologist
</TaxonomyName>
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PY9434
</LicenseNumber>
<LicenseNumberStateCode>
FL
</LicenseNumberStateCode>
<PrimaryTaxonomySwitch>
N
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</Taxonomy>
<Taxonomy>
<TaxonomyCode>
103TB0200X
</TaxonomyCode>
<TaxonomyName>
Cognitive & Behavioral Psychologist
</TaxonomyName>
<LicenseNumber>
PY9434
</LicenseNumber>
<LicenseNumberStateCode>
FL
</LicenseNumberStateCode>
<PrimaryTaxonomySwitch>
N
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<Taxonomy>
<TaxonomyCode>
101YA0400X
</TaxonomyCode>
<TaxonomyName>
Addiction (Substance Use Disorder) Counselor
</TaxonomyName>
<LicenseNumber>
010141-2015
</LicenseNumber>
<LicenseNumberStateCode>
FL
</LicenseNumberStateCode>
<PrimaryTaxonomySwitch>
N
</PrimaryTaxonomySwitch>
</Taxonomy>
</Taxonomies>
<HealthcareProviderTaxonomyGroups/>
</Npi>
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