Healthcare Provider Details

I. General information

NPI: 1972836450
Provider Name (Legal Business Name): MAIA COLEMAN KING PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 K ST NW 605
WASHINGTON DC
20037-1810
US

IV. Provider business mailing address

2141 K ST NW 605
WASHINGTON DC
20037-1810
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-9844
  • Fax: 202-223-9845
Mailing address:
  • Phone: 202-223-9844
  • Fax: 202-223-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1000434
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: