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NPI Code Detail

MEDICARE: MR. RICKY L KING II LCSWA

MEDICARE: MR. RICKY L KING II LCSWA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
21041C0700XClinical Social WorkerP018957NC

General Provider Information

NPI Number : 1013692441
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICKY L KING II LCSWA
Provider Business Mailing Address
First Line : 1304 COZART ST UNIT 504
Second Line :
City : DURHAM
State : NC
Zip : 27704-6225
Country : US
Telephone Number : 313-932-4205
Fax Number :
Provider Business Practice Location Address
First Line : 326 S EUGENE ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27401-2322
Country : US
Telephone Number : 336-310-5098
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2023
Last Update Date : 06/04/2026

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