Provider Demographics
NPI:1114020658
Name:KING, LAURA LENELL (MA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LENELL
Last Name:KING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 SPRING ST
Mailing Address - Street 2:STE 325
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941
Mailing Address - Country:US
Mailing Address - Phone:619-462-2277
Mailing Address - Fax:619-462-2465
Practice Address - Street 1:4215 SPRING ST
Practice Address - Street 2:STE 325
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941
Practice Address - Country:US
Practice Address - Phone:619-462-2277
Practice Address - Fax:619-462-2465
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF48371106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist