MEDICARE: CELESTE KING

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1487513255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTE KING

Provider Business Mailing Address
First Line	:	3695 THEODORE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-3111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3695 THEODORE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48211-3111
Country	:	US
Telephone Number	:	313-459-3172
Fax Number	:

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

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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Directions to “ CELESTE KING ” Practice Location

Language	Start Address	Practice Location

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