Individual
MRS. NICOLE MARIE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
3615 BRASELTON HWY STE 103, DACULA, GA 30019-5907
(678) 377-9634
(678) 377-9609
Mailing address
3615 BRASELTON HWY STE 103, DACULA, GA 30019-5907
(678) 377-9634
(678) 377-9609
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP004282
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000905407C
—
GA
Enumeration date
11/26/2006
Last updated
06/09/2009
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