Provider Demographics
NPI:1215239793
Name:KING-ADAMS, KATRYNA R
Entity type:Individual
Prefix:DR
First Name:KATRYNA
Middle Name:R
Last Name:KING-ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATRYNA
Other - Middle Name:
Other - Last Name:KING-ADAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2600 VAUGHN LAKES BLVD APT 1325
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4628
Mailing Address - Country:US
Mailing Address - Phone:334-235-1189
Mailing Address - Fax:
Practice Address - Street 1:104 BULLOCK DR
Practice Address - Street 2:
Practice Address - City:UNION SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36084
Practice Address - Country:US
Practice Address - Phone:334-738-5685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALN/A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical