Provider Demographics
NPI:1629227244
Name:KING, MONIQUE SHAVON
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:SHAVON
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 1:306 SOLEDAD ST APT 101
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2772
Mailing Address - Country:US
Mailing Address - Phone:831-869-5279
Mailing Address - Fax:
Practice Address - Street 1:306 SOLEDAD ST APT 101
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2772
Practice Address - Country:US
Practice Address - Phone:831-869-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health