Provider Demographics
NPI:1205105798
Name:KING, KATHY MARSHALL (LPAT, ATR-BC, LCADC)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:MARSHALL
Last Name:KING
Suffix:
Gender:F
Credentials:LPAT, ATR-BC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 3RD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BEACH HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-1806
Mailing Address - Country:US
Mailing Address - Phone:808-450-1841
Mailing Address - Fax:
Practice Address - Street 1:326 3RD ST FL 2
Practice Address - Street 2:
Practice Address - City:BEACH HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:08008-1806
Practice Address - Country:US
Practice Address - Phone:808-450-1841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0766101YA0400X
CARALR0770315101YA0400X
NJ16LP00023100101YA0400X
NJ37LC00385200221700000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist