MEDICARE: BRIANA LORRAINE KING 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
1	1041C0700X	Clinical Social Worker	P020230	NC

General Provider Information

NPI Number	:	1679327373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANA LORRAINE KING LCSWA

Provider Business Mailing Address
First Line	:	1265 WATERLOO DR
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-8622
Country	:	US
Telephone Number	:	252-382-3842
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 N WINSTEAD AVE STE 260
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-8757
Country	:	US
Telephone Number	:	252-210-6530
Fax Number	:

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

Provider Enumeration Date	:	04/17/2024
Last Update Date	:	04/17/2024

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