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General NPI Number Information
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NPI Number | 1477813814
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Entity Type | Individual
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Provider Name | DORIS MAE KING MA
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Gender | Female
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | RR 2 BOX 357
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City | CHARLESTON
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State | WV
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Zip | 25314-9733
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Country | US
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Telephone | 304-881-2975
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 385
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City | DUNBAR
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State | WV
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Zip | 25064-0385
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Country | US
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Telephone | 304-881-2975
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1879
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | AP00940294
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License Number State | WV
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