Provider Demographics
NPI:1205284148
Name:KING, KEVIN (LCMHC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 S TRYON ST STE 106
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4688
Mailing Address - Country:US
Mailing Address - Phone:704-266-2351
Mailing Address - Fax:704-360-8076
Practice Address - Street 1:1927 S TRYON ST STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4688
Practice Address - Country:US
Practice Address - Phone:704-266-2351
Practice Address - Fax:704-360-8076
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional