Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 010141-2015 | FL |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 6801078040 | MI |
N | 101YM0800X | Mental Health Counselor | 6801078040 | MI |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY9434 | FL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY9434 | FL |
Y | 103G00000X | Clinical Psychologist | PY9434 | FL |
Y | 103TC0700X | Clinical Psychologist | PY9434 | FL |
N | 1041C0700X | Clinical Social Worker | 6801078040 | MI |
NPI | 1043359193 |
---|---|
Provider Name | Dr. Lisa Marie King |
First Address | Naples, FL 34102-5633 |
Second Address | Naples, FL 34102-5633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 09/11/2015 |