Provider Demographics
NPI:1013757277
Name:KING, NIQUISE MONIQUE (LMFTA)
Entity type:Individual
Prefix:
First Name:NIQUISE
Middle Name:MONIQUE
Last Name:KING
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:NICKI
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFTA
Mailing Address - Street 1:1303 N ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-3239
Mailing Address - Country:US
Mailing Address - Phone:253-426-5001
Mailing Address - Fax:
Practice Address - Street 1:5909 ORCHARD ST W
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-3824
Practice Address - Country:US
Practice Address - Phone:253-752-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61515491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist