Provider Demographics
NPI:1447793500
Name:KING, JOANN ESTHER (LMSW)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:ESTHER
Last Name:KING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 MARION STREET, SUITE 206
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2939
Mailing Address - Country:US
Mailing Address - Phone:803-779-0541
Mailing Address - Fax:803-779-3150
Practice Address - Street 1:1612 MARION ST STE 206
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2939
Practice Address - Country:US
Practice Address - Phone:803-779-0541
Practice Address - Fax:803-779-3150
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2275104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker