Provider Demographics
NPI:1518193127
Name:KING, PHOEBE K (LPC, ACS)
Entity Type:Individual
Prefix:MS
First Name:PHOEBE
Middle Name:K
Last Name:KING
Suffix:
Gender:F
Credentials:LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5035
Mailing Address - Country:US
Mailing Address - Phone:732-359-8686
Mailing Address - Fax:
Practice Address - Street 1:1924 STATE ROUTE 35 STE 9A
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3530
Practice Address - Country:US
Practice Address - Phone:732-359-8686
Practice Address - Fax:732-359-8688
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00057600101YM0800X
NJ37PC00489100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health