Provider Demographics
NPI:1164079786
Name:KING, JON'NAYE NIA
Entity Type:Individual
Prefix:MS
First Name:JON'NAYE
Middle Name:NIA
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9609 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-3213
Mailing Address - Country:US
Mailing Address - Phone:213-631-0408
Mailing Address - Fax:
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 140
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5807
Practice Address - Country:US
Practice Address - Phone:424-320-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst