Provider Demographics
NPI:1962192930
Name:KING, ADA MARIE VILLINGER
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:MARIE VILLINGER
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADA
Other - Middle Name:MARIE MONZO
Other - Last Name:VILLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3536 WAKE RUN CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-1074
Mailing Address - Country:US
Mailing Address - Phone:864-276-1615
Mailing Address - Fax:
Practice Address - Street 1:1664 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7927
Practice Address - Country:US
Practice Address - Phone:470-253-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician