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General NPI Number Information
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NPI Number | 1356814446
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Entity Type | Organization
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Legal Business Name | KING CLARKE CONSULTATION PARTNERS, LLC
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 519 DAVISVILLE RD STE 101
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1525
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Country | US
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Telephone | 267-546-7511
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 S 17TH ST APT 104
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City | PHILADELPHIA
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State | PA
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Zip | 19146-4753
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICAL MANAGER
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Name | INGRID GRACE KING
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Credential | LPC, NCC
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Telephone | 267-546-7511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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