MEDICARE: ELIZABETH KING PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810007623	VA

General Provider Information

NPI Number	:	1699421008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KING PHD

Provider Business Mailing Address
First Line	:	71 WILSON BLVD STE A1
Second Line	:
City	:	FISHERSVILLE
State	:	VA
Zip	:	22939-2283
Country	:	US
Telephone Number	:	540-949-4202
Fax Number	:	540-949-7109

Provider Business Practice Location Address
First Line	:	71 WILSON BLVD STE A1
Second Line	:
City	:	FISHERSVILLE
State	:	VA
Zip	:	22939-2283
Country	:	US
Telephone Number	:	540-949-4202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	02/24/2022

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