Basic Information
| Provider Information | |||||||||
| NPI: | 1841866928 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | GINGER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CADCII | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 DAWSON COMMONS CIR STE 410 | ||||||||
| Address2: | |||||||||
| City: | DAWSONVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305346269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008056989 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 400 DAWSON COMMONS CIR STE 410 | ||||||||
| Address2: | |||||||||
| City: | DAWSONVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305346269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008056989 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2021 | ||||||||
| LastUpdateDate: | 05/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1399 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.