Provider Demographics
NPI:1467605493
Name:KING, ADRIENNE LEIGH DESANTIS (PHD, BCBA-D, NCSP)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:LEIGH DESANTIS
Last Name:KING
Suffix:
Gender:F
Credentials:PHD, BCBA-D, NCSP
Other - Prefix:DR
Other - First Name:ADRIENNE
Other - Middle Name:LEIGH
Other - Last Name:DESANTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:6816 SOUTHPOINT PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1701
Mailing Address - Country:US
Mailing Address - Phone:904-419-7792
Mailing Address - Fax:904-900-7732
Practice Address - Street 1:6816 SOUTHPOINT PKWY STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1701
Practice Address - Country:US
Practice Address - Phone:904-419-7792
Practice Address - Fax:904-900-7732
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-8118103K00000X
FLPY7857103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst