Provider Demographics
NPI:1053490888
Name:KING, DEVON CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:DEVON
Middle Name:CHARLES
Last Name:KING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 PENNSYLVANIA AVE
Mailing Address - Street 2:UNIT 443
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2348
Mailing Address - Country:US
Mailing Address - Phone:267-303-9705
Mailing Address - Fax:215-829-8596
Practice Address - Street 1:245 S 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3520
Practice Address - Country:US
Practice Address - Phone:215-829-5231
Practice Address - Fax:215-829-8596
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015837103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical