Provider Demographics
NPI:1528438850
Name:KING, TAMEKA (LAPC)
Entity type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1884
Mailing Address - Country:US
Mailing Address - Phone:770-577-7873
Mailing Address - Fax:770-577-7871
Practice Address - Street 1:6576 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1884
Practice Address - Country:US
Practice Address - Phone:770-577-7873
Practice Address - Fax:770-577-7871
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004657101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional