Provider Demographics
NPI:1447791066
Name:KING, JOCELYN (LISW)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7700 STATE ROUTE 42 S
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-9401
Mailing Address - Country:US
Mailing Address - Phone:419-989-5325
Mailing Address - Fax:
Practice Address - Street 1:7700 STATE ROUTE 42 S
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44904-9401
Practice Address - Country:US
Practice Address - Phone:419-989-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.165996101YA0400X
OHLCDCIII.161922101YA0400X
OHS.16011651041C0700X, 1041S0200X
OHI.23043021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0273964Medicaid