Provider Demographics
NPI:1912034349
Name:KING, VIVIAN GAIL (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:GAIL
Last Name:KING
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:GAIL
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:318 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276
Mailing Address - Country:US
Mailing Address - Phone:304-519-0503
Mailing Address - Fax:304-927-5201
Practice Address - Street 1:318 MARKET STREET
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-6906
Practice Address - Country:US
Practice Address - Phone:304-519-0503
Practice Address - Fax:304-927-5201
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1069101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional