Provider Demographics
NPI:1184858227
Name:KING, VICTORIA JENEKE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:JENEKE
Last Name:KING
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3802
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94540-3802
Mailing Address - Country:US
Mailing Address - Phone:510-750-4678
Mailing Address - Fax:
Practice Address - Street 1:333 ESTUDILLO AVE STE 206
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4717
Practice Address - Country:US
Practice Address - Phone:510-750-4678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64152106H00000X
CA99231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist