Most Relevant Information
Provider Data
| NPI Number: | 1003550179 |
| Provider Name: | LAVONNE L KING CSWA/QMHP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: | A13468 |
Most Important Dates
| Enumeration Date: | 04/25/2022 |
| Last Updated: | 05/20/2024 |
Provider Practice Location
620 NE 2ND ST
GRESHAM
OR
970307514
Practice Location Phone/Fax
| Phone: | 9712743757 |
| Fax: | 5039125740 |
Provider Mailing Location
1776 SW MADISON ST
PORTLAND
OR
972051715
Provider Mailing Phone/Fax
| Phone: | 5032241044 |
| Fax: | 5036212235 |