Provider Demographics
NPI:1114395233
Name:ALBERT KING, AUDREY (R-DMT, MA, CMA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:ALBERT KING
Suffix:
Gender:F
Credentials:R-DMT, MA, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 SYMMES CIR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-2984
Mailing Address - Country:US
Mailing Address - Phone:617-954-6838
Mailing Address - Fax:
Practice Address - Street 1:500 VICTORY RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-3139
Practice Address - Country:US
Practice Address - Phone:617-774-1490
Practice Address - Fax:617-774-1490
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health