Provider Demographics
NPI:1689269292
Name:KING, ERIC WILLIAM
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:WILLIAM
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S ANTLER ST
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-2104
Mailing Address - Country:US
Mailing Address - Phone:410-456-2748
Mailing Address - Fax:
Practice Address - Street 1:RISE CENTER FOR AUTISM
Practice Address - Street 2:1070 W. HOUGHTON LAKE MI 48651
Practice Address - City:PRUDENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48619
Practice Address - Country:US
Practice Address - Phone:989-202-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician