Basic Information
| Provider Information | |||||||||
| NPI: | 1619929155 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | W. | ||||||||
| MiddleName: | SHAWNTAY | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STARKS | ||||||||
| OtherFirstName: | WELVIA | ||||||||
| OtherMiddleName: | SHAWNTAY | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 215 N. MAGNOLIA ST. | ||||||||
| Address2: | SWCMHC | ||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291511946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037759364 | ||||||||
| FaxNumber: | 8037736615 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 N. GUIGNARD DR. | ||||||||
| Address2: | SWCMHC/CAF | ||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291511946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037757898 | ||||||||
| FaxNumber: | 8037735246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.