Provider Demographics
NPI:1629211396
Name:KING, DEANNA MARIE
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W 155TH STREET,
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247
Mailing Address - Country:US
Mailing Address - Phone:310-512-8100
Mailing Address - Fax:310-324-2111
Practice Address - Street 1:1300 W 155TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4048
Practice Address - Country:US
Practice Address - Phone:310-512-8100
Practice Address - Fax:310-324-2111
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health