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General NPI Number Information
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NPI Number | 1790197119
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Entity Type | Individual
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Provider Name | EMILY KING
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Gender | Female
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 501 MIZE ST
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City | LA FAYETTE
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State | GA
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Zip | 30728-3346
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Country | US
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Telephone | 706-806-1120
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 179
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City | APISON
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State | TN
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Zip | 37302-0179
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Country | US
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Telephone | 937-205-8689
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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 | APC004370
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License Number State | GA
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