Provider Demographics
NPI:1285350801
Name:KING, VICTORIA MORGAN
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MORGAN
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7286
Mailing Address - Country:US
Mailing Address - Phone:334-491-3020
Mailing Address - Fax:334-356-8050
Practice Address - Street 1:114 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-7286
Practice Address - Country:US
Practice Address - Phone:334-491-3020
Practice Address - Fax:334-356-8050
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
ALRBT-23-278046106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician