MEDICARE: MS. DONITA MARIE KING LMFT

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	106H00000X	Marriage & Family Therapist	MFTI 62067	CA
2	106H00000X	Marriage & Family Therapist	105278	CA

General Provider Information

NPI Number	:	1720310204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONITA MARIE KING LMFT

Provider Business Mailing Address
First Line	:	PO BOX 2593
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-1950
Country	:	US
Telephone Number	:	530-557-5509
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 PROVIDENCE MINE RD STE 103E
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-2937
Country	:	US
Telephone Number	:	530-557-5509
Fax Number	:

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

Provider Enumeration Date	:	02/08/2010
Last Update Date	:	05/07/2018

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