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General NPI Number Information
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NPI Number | 1912144213
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Entity Type | Individual
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Provider Name | CYNTHIA RENE'A KING-HARRIS M.S.,L.M.H.C.
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Gender | Female
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 3603 E JEFFERSON BLVD
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City | SOUTH BEND
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State | IN
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Zip | 46615-3035
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Country | US
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Telephone | 574-298-8931
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6122
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City | SOUTH BEND
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State | IN
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Zip | 46660-6122
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Country | US
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Telephone | 574-298-8931
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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 | 39001737A
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License Number State | IN
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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 | 33001862A
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License Number State | IN
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