Individual
LA DETRIA KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2610 COMMONS BLVD, SUITE B, AUGUSTA, GA 30909-2080
(706) 832-6679
Mailing address
2918 HENRY ST, AUGUSTA, GA 30909-3848
(706) 832-6679
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC006088
GA
Other
Enumeration date
11/11/2012
Last updated
11/11/2012
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