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General NPI Number Information
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NPI Number | 1770878514
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Entity Type | Individual
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Provider Name | CANDICE KING
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Gender | Female
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 06/09/2011
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Provider Practice Location Address
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Address Line | 14930 LAPLAISANCE RD
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City | MONROE
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State | MI
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Zip | 48161-3880
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Country | US
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Telephone | 734-240-3850
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 CORBIN RD
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City | TOLEDO
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State | OH
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Zip | 43612-2323
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Country | US
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Telephone | 419-476-7441
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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 | C0700328
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License Number State | OH
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