Provider Demographics
NPI:1215542592
Name:KING, CHRISTINE (TLLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 LAKE KNOLLS DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5411
Mailing Address - Country:US
Mailing Address - Phone:248-933-9691
Mailing Address - Fax:
Practice Address - Street 1:4200 LAKE KNOLLS DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-5411
Practice Address - Country:US
Practice Address - Phone:248-933-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical