Provider Demographics
NPI:1114637048
Name:KING, MALACHI (LSAA,CPSW)
Entity type:Individual
Prefix:
First Name:MALACHI
Middle Name:
Last Name:KING
Suffix:
Gender:
Credentials:LSAA,CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7384 VISTA DE SOBRE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-0773
Mailing Address - Country:US
Mailing Address - Phone:575-202-6134
Mailing Address - Fax:
Practice Address - Street 1:7384 VISTA DE SOBRE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-0773
Practice Address - Country:US
Practice Address - Phone:575-202-6134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1353175T00000X
NMCTB-2025-0172101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist