Provider Demographics
NPI:1386843597
Name:KING, GLORIA LEE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:LEE
Last Name:KING
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 WING ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4638
Mailing Address - Country:US
Mailing Address - Phone:619-947-2098
Mailing Address - Fax:619-947-2098
Practice Address - Street 1:1141 5TH AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2855
Practice Address - Country:US
Practice Address - Phone:619-947-2098
Practice Address - Fax:619-947-2098
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49962106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist