Provider Demographics
NPI:1720807167
Name:KING, VANESSA (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:KING
Suffix:
Gender:
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 PYRAMID DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3210
Mailing Address - Country:US
Mailing Address - Phone:214-453-7878
Mailing Address - Fax:
Practice Address - Street 1:4400 BELT LINE ROAD
Practice Address - Street 2:SUITE 1037
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001
Practice Address - Country:US
Practice Address - Phone:214-453-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health