Provider Demographics
NPI:1912232414
Name:KING, JOHN MARK (MA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARK
Last Name:KING
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 GLADES CIR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-5016
Mailing Address - Country:US
Mailing Address - Phone:727-463-2938
Mailing Address - Fax:
Practice Address - Street 1:304 GLADES CIR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5016
Practice Address - Country:US
Practice Address - Phone:727-463-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor