| Michael King Lcsw Llc | |
|
201 Cove Rd Jasper GA 30143-1356 | |
| (706) 253-9515 | |
| (706) 253-9516 |
| Full Name | Michael King Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 201 Cove Rd, Jasper, Georgia |
| Authorized Official Name and Position | Michael Estel King (SOLE PROPRIETOR) |
| Authorized Official Contact | 7066693526 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael King Lcsw Llc 201 Cove Rd Jasper GA 30143-1356 Ph: (706) 253-9515 | Michael King Lcsw Llc 201 Cove Rd Jasper GA 30143-1356 Ph: (706) 253-9515 |
| NPI Number | 1578091252 |
|---|---|
| Provider Enumeration Date | 05/25/2017 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 7911272836 |
|---|---|
| Medicare Enrollment ID | O20171003006088 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578091252 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW006094 (Georgia) | Primary |
| Provider Name | Michael Estel King |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386172047 PECOS PAC ID: 2365512191 Enrollment ID: I20171003006274 |
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