Provider Demographics
NPI:1902136070
Name:KING, JASON DEWAYNE (MA, TCADC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DEWAYNE
Last Name:KING
Suffix:
Gender:M
Credentials:MA, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 568
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-0568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14892 N US HIGHWAY 25 E STE 3
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6190
Practice Address - Country:US
Practice Address - Phone:606-526-9348
Practice Address - Fax:606-526-1541
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY278213101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health