Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 12346 | MD |
Y | 1041C0700X | Clinical Social Worker | LC50078213 | DC |
NPI | 1003251661 |
---|---|
Provider Name | Mr. Michael King JR. |
First Address | Bowie, MD 20721-1814 |
Second Address | Bowie, MD 20721-1814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2013 |
Last Update Date | 24/02/2021 |