Provider Demographics
NPI:1568849339
Name:MOSS-KING, DAVINA (PHD)
Entity Type:Individual
Prefix:
First Name:DAVINA
Middle Name:
Last Name:MOSS-KING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FOUNTAIN PLZ STE 1400
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-2215
Mailing Address - Country:US
Mailing Address - Phone:716-961-3434
Mailing Address - Fax:716-906-8118
Practice Address - Street 1:50 FOUNTAIN PLZ STE 1400
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2215
Practice Address - Country:US
Practice Address - Phone:716-961-3434
Practice Address - Fax:716-906-8118
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY17662101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor