Provider Demographics
NPI:1962282293
Name:KING, CASSANDRA (MSW)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30728 COUNTRY RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1107
Mailing Address - Country:US
Mailing Address - Phone:313-410-5482
Mailing Address - Fax:
Practice Address - Street 1:25700 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5809
Practice Address - Country:US
Practice Address - Phone:248-415-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9049104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker