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General NPI Number Information
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NPI Number | 1154706315
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Entity Type | Individual
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Provider Name | LU ANN KING MSW, LCDC III, LSW
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Gender | Female
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 1641 PAYNE AVE SUITE 190
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City | CLEVELAND
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State | OH
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Zip | 44114-2919
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Country | US
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Telephone | 216-987-6357
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Fax | 216-787-7883
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Provider Business Mailing Address
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Address Line | 1641 PAYNE AVE SUITE 190
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City | CLEVELAND
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State | OH
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Zip | 44114-2919
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Country | US
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Telephone | 216-987-6357
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Fax | 216-787-7883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 131062
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S0031268
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License Number State | OH
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