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General NPI Number Information
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NPI Number | 1780069013
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Entity Type | Individual
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Provider Name | SUSAN KING LPCC
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Gender | Female
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 411 SAINT MICHAELS DR STE 2
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City | SANTA FE
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State | NM
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Zip | 87505-7655
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Country | US
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Telephone | 505-057-7721
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Fax |
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Provider Business Mailing Address
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Address Line | 1566 SIPAPU LN
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City | SANTA FE
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State | NM
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Zip | 87507-4012
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Country | US
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Telephone | 505-660-2888
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CCMN0200241
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License Number State | NM
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