MEDICARE: DR. HEIDI MARIE 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	0810005018	VA

General Provider Information

NPI Number	:	1659778454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI MARIE KING PHD

Provider Business Mailing Address
First Line	:	13800 COPPERMINE RD
Second Line	:	1ST FLOOR
City	:	HERNDON
State	:	VA
Zip	:	20171-6163
Country	:	US
Telephone Number	:	703-822-1381
Fax Number	:

Provider Business Practice Location Address
First Line	:	13800 COPPERMINE RD
Second Line	:	1ST FLOOR
City	:	HERNDON
State	:	VA
Zip	:	20171-6163
Country	:	US
Telephone Number	:	703-822-1381
Fax Number	:

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

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	07/29/2015

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