Provider Demographics
NPI:1548752512
Name:KING, KATRINA KYRENE (PEER COUNSELOR)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:KYRENE
Last Name:KING
Suffix:
Gender:F
Credentials:PEER COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12118 HIGHWAY 99 APT F402
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-0065
Mailing Address - Country:US
Mailing Address - Phone:425-215-9397
Mailing Address - Fax:
Practice Address - Street 1:3322 BROADWAY # LEVEL1NA
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4425
Practice Address - Country:US
Practice Address - Phone:425-405-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor