Provider Demographics
NPI:1063114783
Name:KING'S MINDFULNESS CENTER
Entity type:Organization
Organization Name:KING'S MINDFULNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:732-278-5459
Mailing Address - Street 1:1358 HOOPER AVE UNIT 394
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2882
Mailing Address - Country:US
Mailing Address - Phone:732-278-5459
Mailing Address - Fax:732-279-3074
Practice Address - Street 1:525 LACEY RD STE E2
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1543
Practice Address - Country:US
Practice Address - Phone:732-278-5459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty