Provider Demographics
NPI:1386172047
Name:KING, MICHAEL ESTEL (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ESTEL
Last Name:KING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 COVE RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1356
Mailing Address - Country:US
Mailing Address - Phone:706-253-9515
Mailing Address - Fax:706-253-9516
Practice Address - Street 1:201 COVE RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1356
Practice Address - Country:US
Practice Address - Phone:706-669-3526
Practice Address - Fax:706-253-9516
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0060941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical