Provider Demographics
NPI:1851590038
Name:KING, TAMMY J
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
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 1:807 S GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3158
Mailing Address - Country:US
Mailing Address - Phone:717-843-6561
Mailing Address - Fax:717-845-6941
Practice Address - Street 1:807 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3158
Practice Address - Country:US
Practice Address - Phone:717-843-6561
Practice Address - Fax:717-845-6941
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional