Provider Information for 1558536110
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Ms. BRENDA STUBBS KING LPC
Sex: Female
NPI: 1558536110
Last Updated: 2009-10-05
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1558536110 | ||||||||
| Enumeration Date | 2008-04-24 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2020 AVALON PKWY SUITE 185 MCDONOUGH, GA 30253-3054 United States Phone: 678-833-1820 | Fax:678-833-1821 | ||||||||
| Primary Practice Address | 2020 AVALON PKWY SUITE 185 MCDONOUGH, GA 30253-3054 United States Phone: 678-833-1820 | Fax:678-833-1821 | ||||||||
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