Provider Demographics
NPI:1114211802
Name:KING, ISABELLE B (BS, MED, PHD)
Entity Type:Individual
Prefix:DR
First Name:ISABELLE
Middle Name:B
Last Name:KING
Suffix:
Gender:F
Credentials:BS, MED, PHD
Other - Prefix:DR
Other - First Name:ISABELLE
Other - Middle Name:BRAGG
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS,MED,PHD
Mailing Address - Street 1:PO BOX 730427
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-0427
Mailing Address - Country:US
Mailing Address - Phone:386-871-7727
Mailing Address - Fax:386-673-8329
Practice Address - Street 1:1452 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6638
Practice Address - Country:US
Practice Address - Phone:386-871-7727
Practice Address - Fax:386-673-8329
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 1686103T00000X
FLFACCT CPY0329010311103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist