Individual
MIRANDA KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-T
Contact information
Practice address
25 WILLOWBROOK RD, QUEENSBURY, NY 12804-5882
(518) 926-7200
Mailing address
25 WILLOWBROOK RD # CFR, QUEENSBURY, NY 12804-5882
(518) 926-7200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37951
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236
—
NY
01
—
568946544
BCBS
NY
01
—
5874
HEALTH PARTNERS
—
Enumeration date
08/23/2022
Last updated
08/23/2022
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