Provider Demographics
NPI:1669886438
Name:KING, KRISTEN DAWN
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:DAWN
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:DAWN
Other - Last Name:MARIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:212 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2521
Mailing Address - Country:US
Mailing Address - Phone:609-891-5551
Mailing Address - Fax:
Practice Address - Street 1:212 11TH ST
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2521
Practice Address - Country:US
Practice Address - Phone:609-891-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health