Provider Demographics
NPI:1710368352
Name:KING, ROSA VERA (LCPC)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:VERA
Last Name:KING
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 175TH ST STE 319
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2073
Mailing Address - Country:US
Mailing Address - Phone:708-928-3288
Mailing Address - Fax:
Practice Address - Street 1:935 175TH ST STE 319
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2073
Practice Address - Country:US
Practice Address - Phone:708-928-3288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health