Provider Demographics
NPI:1386865368
Name:KING, JEANMARIE (CADC II)
Entity Type:Individual
Prefix:
First Name:JEANMARIE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5536 LIME AVE APT B
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-5581
Mailing Address - Country:US
Mailing Address - Phone:562-394-7413
Mailing Address - Fax:
Practice Address - Street 1:5536 LIME AVE APT B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-5581
Practice Address - Country:US
Practice Address - Phone:310-519-3400
Practice Address - Fax:310-519-1309
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA08720315101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1989Medicaid