MEDICARE: MR. ROBERT LEE KING LPC

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
1	101YP2500X	Professional Counselor	9483	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336279553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LEE KING LPC

Provider Business Mailing Address
First Line	:	209 S FUQUAY AVE
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-2254
Country	:	US
Telephone Number	:	919-552-9550
Fax Number	:	919-552-3405

Provider Business Practice Location Address
First Line	:	209 S FUQUAY AVE
Second Line	:
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-2254
Country	:	US
Telephone Number	:	919-552-9550
Fax Number	:	919-552-3405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/24/2012

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