Provider Demographics
NPI:1245584333
Name:KING, TRINA LOUISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:LOUISE
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 NEEDHAM ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0730
Mailing Address - Country:US
Mailing Address - Phone:209-569-0373
Mailing Address - Fax:209-569-0373
Practice Address - Street 1:621 14TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2504
Practice Address - Country:US
Practice Address - Phone:209-569-0373
Practice Address - Fax:209-569-0373
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X, 390200000X
LCSW760581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program