Provider Demographics
NPI:1467873844
Name:KING, ELIZABETH VAIL (ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:VAIL
Last Name:KING
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4113
Mailing Address - Country:US
Mailing Address - Phone:267-587-6257
Mailing Address - Fax:
Practice Address - Street 1:5120 IRVING ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4113
Practice Address - Country:US
Practice Address - Phone:267-587-6257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional