Individual
DEBORA KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC, ATR-BC
Contact information
Practice address
255 S 17TH ST STE 1301, PHILADELPHIA, PA 19103-6213
(215) 821-9621
Mailing address
1206 TITAN ST, PHILADELPHIA, PA 19147-4508
(267) 838-7255
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PC012584
PA
101YP2500X
Professional Counselor
PC012584
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30789632
OTHER
PA
05
—
30789632
—
PA
Enumeration date
05/12/2021
Last updated
03/04/2022
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