Provider Demographics
NPI:1801949623
Name:KING, STORM (PH D)
Entity type:Individual
Prefix:
First Name:STORM
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1244
Mailing Address - Country:US
Mailing Address - Phone:413-525-9316
Mailing Address - Fax:
Practice Address - Street 1:21 REDSTONE DR
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1244
Practice Address - Country:US
Practice Address - Phone:413-525-9316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor