=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093943763
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN HASKINS KING PHD, LPC, LMFT, NCC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2009
-----------------------------------------------------
Last Update Date | 07/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 912 NORTH ELM STREET
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-558-4720
-----------------------------------------------------
Fax | 336-274-4647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 912 NORTH ELM STREET
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-558-4720
-----------------------------------------------------
Fax | 336-274-4647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 673
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 583
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------