Provider Demographics
NPI:1750787891
Name:KING, NICHOLE (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26926 CAMPAU LN
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-2443
Mailing Address - Country:US
Mailing Address - Phone:586-855-7330
Mailing Address - Fax:
Practice Address - Street 1:131 MARKET ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1762
Practice Address - Country:US
Practice Address - Phone:586-463-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010942131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical