Provider Demographics
NPI:1588538797
Name:KING-JEROME, CONNIE (MSW,LCSW-A)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:KING-JEROME
Suffix:
Gender:F
Credentials:MSW,LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 SOUTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5096
Mailing Address - Country:US
Mailing Address - Phone:919-332-9294
Mailing Address - Fax:
Practice Address - Street 1:503 US 70 HWY E STE R
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4058
Practice Address - Country:US
Practice Address - Phone:919-322-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0229061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty