Provider Demographics
NPI:1700165461
Name:KING, SDHARI ANTOINETTE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SDHARI
Middle Name:ANTOINETTE
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 1:14 S HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:23075-1344
Mailing Address - Country:US
Mailing Address - Phone:804-652-7283
Mailing Address - Fax:
Practice Address - Street 1:14 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:23075-1344
Practice Address - Country:US
Practice Address - Phone:804-652-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040077211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical