Provider Demographics
NPI:1104938158
Name:KING, COLLEEN (MFT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CADILLAC DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8349
Mailing Address - Country:US
Mailing Address - Phone:916-295-1819
Mailing Address - Fax:916-295-1819
Practice Address - Street 1:25 CADILLAC DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8349
Practice Address - Country:US
Practice Address - Phone:916-295-1819
Practice Address - Fax:916-295-1819
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48369106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist