Provider Demographics
NPI:1174366389
Name:KING, KATHERINE E (MA, MDIV, MSW, LMSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:MA, MDIV, MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 OFFICE PARK DR STE D
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3597
Mailing Address - Country:US
Mailing Address - Phone:662-381-5110
Mailing Address - Fax:
Practice Address - Street 1:1204 OFFICE PARK DR STE D
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3597
Practice Address - Country:US
Practice Address - Phone:662-381-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM10748104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker