Provider Demographics
NPI:1154169712
Name:KING, MARY KATHERINE (MS, NCC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:KING
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5118 PARK AVE STE 505
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5713
Mailing Address - Country:US
Mailing Address - Phone:629-777-6430
Mailing Address - Fax:
Practice Address - Street 1:5118 PARK AVE STE 505
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5713
Practice Address - Country:US
Practice Address - Phone:901-528-9863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health