Individual
TEJUANA L KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, CSAC
Contact information
Practice address
1126 S. 70TH STREET, SUITE S-507, MILWAUKEE, WI 53214
(414) 727-2789
(414) 476-8695
Mailing address
1126 S. 70TH STREET, SUITE S-507, MILWAUKEE, WI 53214
(414) 727-2789
(414) 476-8695
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
13881-132
WI
1041C0700X
Clinical Social Worker
Primary
7256-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40976800
—
WI
Enumeration date
11/01/2006
Last updated
09/25/2007
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