Provider Demographics
NPI:1750762688
Name:KING, LILLA
Entity type:Individual
Prefix:
First Name:LILLA
Middle Name:
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 1:1892 BRITTANY LN SW
Mailing Address - Street 2:APARTMENT 2314
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-0487
Mailing Address - Country:US
Mailing Address - Phone:360-528-0638
Mailing Address - Fax:
Practice Address - Street 1:1892 BRITTANY LN SW
Practice Address - Street 2:APARTMENT 2314
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-0487
Practice Address - Country:US
Practice Address - Phone:360-528-0638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60493733101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor