Provider Demographics
NPI:1417579137
Name:KING, JARIVA (LMSW)
Entity type:Individual
Prefix:MS
First Name:JARIVA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9245 CUANDET RD APT 96
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4763
Mailing Address - Country:US
Mailing Address - Phone:601-867-1048
Mailing Address - Fax:
Practice Address - Street 1:9245 CUANDET RD APT 96
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4763
Practice Address - Country:US
Practice Address - Phone:601-867-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM9627104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSM9627Medicaid