Provider Demographics
NPI:1396273892
Name:KING, ANGELA (LMSW, LSAA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LMSW, LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MADRID AVE
Mailing Address - Street 2:
Mailing Address - City:MORIARTY
Mailing Address - State:NM
Mailing Address - Zip Code:87035-5355
Mailing Address - Country:US
Mailing Address - Phone:580-665-2044
Mailing Address - Fax:
Practice Address - Street 1:2727 SAN PEDRO DR NE STE 110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3373
Practice Address - Country:US
Practice Address - Phone:580-665-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-0766104100000X
NMCSA0211931101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)