Provider Demographics
NPI:1396589735
Name:KING, LISA DEAN
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:DEAN
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 1:80 CARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-1420
Mailing Address - Country:US
Mailing Address - Phone:717-503-7645
Mailing Address - Fax:
Practice Address - Street 1:4 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1314
Practice Address - Country:US
Practice Address - Phone:215-757-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health