Provider Demographics
NPI:1871000224
Name:COX, JAYMIN (LMSW, CAADC)
Entity Type:Individual
Prefix:
First Name:JAYMIN
Middle Name:
Last Name:COX
Suffix:
Gender:M
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 WINGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6529
Mailing Address - Country:US
Mailing Address - Phone:734-262-3763
Mailing Address - Fax:
Practice Address - Street 1:575 S MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1778
Practice Address - Country:US
Practice Address - Phone:734-451-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011004571041C0700X
MI68011059241041C0700X
MIC-03797101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)