Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor | 37PC00443500 | NJ |
NPI | 1225133564 |
---|---|
Provider Name | Mrs. Carol M King |
First Address | Spring Lake, NJ 07762-1946 |
Second Address | Manasquan, NJ 08736-3440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 26/06/2013 |