Provider Demographics
NPI:1992953491
Name:KING, ELMIRA J (LCSW)
Entity type:Individual
Prefix:
First Name:ELMIRA
Middle Name:J
Last Name:KING
Suffix:
Gender:F
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:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-0366
Mailing Address - Country:US
Mailing Address - Phone:804-869-2960
Mailing Address - Fax:804-883-5983
Practice Address - Street 1:100 ARBOR OAK DR STE 205A
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2261
Practice Address - Country:US
Practice Address - Phone:804-869-2960
Practice Address - Fax:804-883-5983
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040027871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190001140OtherMEDICARE