Provider Demographics
NPI:1942872999
Name:KING, LAURA ROSE (LCSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ROSE
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-0102
Mailing Address - Country:US
Mailing Address - Phone:573-413-7882
Mailing Address - Fax:
Practice Address - Street 1:313 W COUNTRY CLUB RD STE 9
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5804
Practice Address - Country:US
Practice Address - Phone:575-347-1883
Practice Address - Fax:737-201-2725
Is Sole Proprietor?:No
Enumeration Date:2021-07-10
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2022-05341041C0700X
NMM-117861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMSWB20220534OtherLCSW
NMM-11786OtherLMSW