Provider Demographics
NPI:1508755547
Name:KING, BROOKE LEILANI
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEILANI
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6712 AVERETT CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-3724
Mailing Address - Country:US
Mailing Address - Phone:808-339-2126
Mailing Address - Fax:
Practice Address - Street 1:5219 KINGS WOOD LN
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-5612
Practice Address - Country:US
Practice Address - Phone:540-750-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician