Provider Demographics
NPI:1265746390
Name:KING, JESSICA JOTTNIECE RUSH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JOTTNIECE RUSH
Last Name:KING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:JOTTNIECE
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2085 RUSTIN AVE.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2498
Mailing Address - Country:US
Mailing Address - Phone:951-955-8000
Mailing Address - Fax:951-955-8010
Practice Address - Street 1:2085 RUSTIN AVE.
Practice Address - Street 2:SUITE 4
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2498
Practice Address - Country:US
Practice Address - Phone:951-955-8000
Practice Address - Fax:951-955-8010
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28633101YM0800X
CA713951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health