Healthcare Provider Details

I. General information

NPI: 1144135310
Provider Name (Legal Business Name): NIKI G KING MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 N BROADWAY PH E
JERICHO NY
11753-2198
US

IV. Provider business mailing address

368 VETERANS MEMORIAL HWY STE 3
COMMACK NY
11725-4322
US

V. Phone/Fax

Practice location:
  • Phone: 631-533-0315
  • Fax:
Mailing address:
  • Phone: 631-533-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP144668
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: