Provider Demographics
NPI:1669212536
Name:KING, HANNIEL (LSW)
Entity type:Individual
Prefix:
First Name:HANNIEL
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 CHESWOLD RD APT 4
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3519
Mailing Address - Country:US
Mailing Address - Phone:215-997-2000
Mailing Address - Fax:
Practice Address - Street 1:6930-34 WEST MARKET STREET
Practice Address - Street 2:FLOOR 2
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2308
Practice Address - Country:US
Practice Address - Phone:215-997-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional