Healthcare Provider Details

I. General information

NPI: 1043521909
Provider Name (Legal Business Name): SHANADRAL KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44459 10TH ST W
LANCASTER CA
93534-3324
US

IV. Provider business mailing address

44459 10TH ST W
LANCASTER CA
93534-3324
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2630
  • Fax:
Mailing address:
  • Phone: 661-726-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC4681214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: