Provider Demographics
NPI:1255933313
Name:KING, NATASHA MALENE (LLPC)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:MALENE
Last Name:KING
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14146 NORBORNE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2941
Mailing Address - Country:US
Mailing Address - Phone:248-910-5198
Mailing Address - Fax:
Practice Address - Street 1:14146 NORBORNE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-2941
Practice Address - Country:US
Practice Address - Phone:248-910-5198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health