Active NPI
Andrea Jean King, LSW
- Social Worker
- Mansfield, OH
National Provider Identifier
1154856698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- S.1904156
- Practice address
- 775 Lexington Ave
Mansfield, OH 44907-1906 - Phone
- (419) 774-4110
- NPI assigned
- Apr 21, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 150041 | OH | |
| Social Worker | 104100000X | S.1904156 | OH | Primary |
Addresses
Primary practice location
775 Lexington Ave
Mansfield, OH 44907-1906
Mailing address
2000 Noble Dr
Wooster, OH 44691-5353
Phone (330) 264-3232
Other practice location 1
151 Marion Ave
Mansfield, OH 44903-2223
Phone (419) 774-9969
Other practice location 2
2775 State Route 39
Shelby, OH 44875
Phone (419) 747-3322
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150041 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| S.1904156 | OH | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornell Abraxas Group, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Children's Substance Abuse Rehabilitation Facility
- Shelby, OH
- NPI 1376518902
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617926400000",
"number": "1154856698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 NOBLE DR",
"city": "WOOSTER",
"state": "OH",
"postal_code": "446915353",
"telephone_number": "330-264-3232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "775 LEXINGTON AVE",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449071906",
"telephone_number": "419-774-4110"
}
],
"practiceLocations": [
{
"address_1": "151 Marion Ave",
"address_purpose": "LOCATION",
"city": "Mansfield",
"state": "OH",
"postal_code": "449032223",
"country_code": "US",
"telephone_number": "419-774-9969",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2775 State Route 39",
"address_purpose": "LOCATION",
"city": "Shelby",
"state": "OH",
"postal_code": "44875",
"country_code": "US",
"telephone_number": "419-747-3322",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KING",
"first_name": "ANDREA",
"middle_name": "JEAN",
"name_prefix": "Mrs.",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-21",
"last_updated": "2021-04-09",
"certification_date": "2021-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "150041",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.1904156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.