Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CDCA.175575 | OH |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | CDCA.175575 | OH |
NPI | 1356006803 |
---|---|
Provider Name | Kayla Patricia King |
First Address | Goshen, OH 45122 |
Second Address | Goshen, OH 45122-9414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2021 |
Last Update Date | 01/11/2021 |