Provider Demographics
NPI:1548014806
Name:KING, KRISTIN MARIE (LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 BUCHANAN AVE
Mailing Address - Street 2:
Mailing Address - City:CROYDON
Mailing Address - State:PA
Mailing Address - Zip Code:19021-8007
Mailing Address - Country:US
Mailing Address - Phone:267-916-7976
Mailing Address - Fax:
Practice Address - Street 1:2030 BUCHANAN AVE
Practice Address - Street 2:
Practice Address - City:CROYDON
Practice Address - State:PA
Practice Address - Zip Code:19021-8007
Practice Address - Country:US
Practice Address - Phone:267-916-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC16464101YP2500X
PAP0C014245101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional