Provider Demographics
NPI:1477148963
Name:KING, RYEMAINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RYEMAINE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27930 CABOT RD UNIT 525
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1109
Mailing Address - Country:US
Mailing Address - Phone:317-464-7878
Mailing Address - Fax:
Practice Address - Street 1:21632 WESLEY DR
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-8167
Practice Address - Country:US
Practice Address - Phone:949-499-5346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist