Provider Demographics
NPI:1548329956
Name:KING, DEBRA H (LSCSW, TLAC)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:H
Last Name:KING
Suffix:
Gender:F
Credentials:LSCSW, TLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4618
Mailing Address - Country:US
Mailing Address - Phone:785-842-2875
Mailing Address - Fax:
Practice Address - Street 1:1739 E 23RD ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5017
Practice Address - Country:US
Practice Address - Phone:785-830-8238
Practice Address - Fax:785-830-8246
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS37081041C0700X
KS1004101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)