Organization
KING OF HEARTS LIFE ENHANCEMENT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TARA MICHELLE KING LPC, LCADC (DIRECTOR)
(732) 240-2545
Entity
Organization
Contact information
Practice address
522 BRICK BLVD, BRICK, NJ 08723-6089
(732) 240-2545
(732) 475-6265
Mailing address
522 BRICK BLVD, BRICK, NJ 08723-6089
(732) 240-2545
(732) 475-6265
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37LC00034800
NJ
101YP2500X
Professional Counselor
37PC00161400
NJ
Other
Enumeration date
02/20/2015
Last updated
02/20/2015
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