Provider Demographics
NPI:1033002449
Name:KING, ACHANTEE TATIANA
Entity type:Individual
Prefix:
First Name:ACHANTEE
Middle Name:TATIANA
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 1:361 ALTAMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-7807
Mailing Address - Country:US
Mailing Address - Phone:419-544-1810
Mailing Address - Fax:
Practice Address - Street 1:523 N SELTZER ST
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-1440
Practice Address - Country:US
Practice Address - Phone:419-405-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health