Provider Demographics
NPI:1417443250
Name:KING, SOPHIA ANICE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:ANICE
Last Name:KING
Suffix:
Gender:F
Credentials:BCBA, LBA
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 10639
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-2639
Mailing Address - Country:US
Mailing Address - Phone:541-345-0805
Mailing Address - Fax:
Practice Address - Street 1:555 E 15TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4314
Practice Address - Country:US
Practice Address - Phone:541-345-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-B-10194544103K00000X
1-18-30364103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst