MEDICARE: CHRISTIANA MICHELLE KING LGPC

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	101YM0800X	Mental Health Counselor	LGP10923	MD

General Provider Information

NPI Number	:	1861090250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIANA MICHELLE KING LGPC

Provider Business Mailing Address
First Line	:	3510 WORTHINGTON BLVD UNIT 101
Second Line	:
City	:	URBANA
State	:	MD
Zip	:	21704-7066
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 WORTHINGTON BLVD UNIT 101
Second Line	:
City	:	URBANA
State	:	MD
Zip	:	21704-7066
Country	:	US
Telephone Number	:	301-606-4548
Fax Number	:

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

Provider Enumeration Date	:	10/16/2020
Last Update Date	:	10/16/2020

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