Provider Demographics
NPI:1144981739
Name:KING, MICHELLE LISA (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LISA
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 1:3550 WAKE ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-8138
Mailing Address - Country:US
Mailing Address - Phone:678-203-8005
Mailing Address - Fax:
Practice Address - Street 1:188 GODDARD RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1604
Practice Address - Country:US
Practice Address - Phone:678-203-8005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC239951041C0700X
UT14137606-35011041C0700X
VT089.01345351041C0700X
GACSW0071941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical